HomeMy WebLinkAboutHomestead_HembreeINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.PREPARER
Christina Feruason Closinq Aaent
Preparero(theSalaDiulosureFOrm - . TiUe
501 Main SL Suite 101 Bosse Title Comoanv
Addras(Num6erund5veeq lompany
Evansville. IN 47708
Ciry, Smte, and ZIPCade TMephone Number E-mail
E:SELLER S GRANTOR S . ^' -- •�� } "� ° : ;:.`, _- -
Lloyd F.Jones Karen A_Jones
7S�eller I- Name as appears om m�veyunce docvmmt Seller 2- A'�aAme as appmrs om m�veya�n7ce docvment
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Ciry,
Tele honeNumber E-mail Tefe honeNumber E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o [he best of my knowledge and belief, is [rue, correct
and c mplete as •equ'red by law, and is prepared in actordance with IC 64.1-5.5, "Real Proper[y Sales Disdosure AcY'.
� �� � - �-�
9gnamre SJer S�gnamreo(Seller
Karen A. Jones 07/15I2013
n[edNamea Shcer Si nDare MM/DD Prm�edNameo Selier Si nDaref.vr/�n/rvrvl
F:'BUYERS GRANTEES =APPLICATIONFORPROPERTY-TAX'DEDUCTION5=IDENTIEY"ALLITEMS�THATAP,P.GY'.' - -
Ja n K. Hembr e
-Namea omm�veyanredocument Buyer2-Nameatappearsomm�veyanredocvment
2782 S 1200 E
Addreu(NUm6erand5veet) Addrea(Num6erandSveeQ
Oakland CiN IN 47660
Tefe honeh'umber E�moil Tele haneA'um6er E-mail
TNE SALFS DISCLOSURE FORM hL1Y BE USED TO APPLY FOR CERTAIN UEDURIONS FOR TNLS PFOPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION 1 \0 COYOITION
Q � 1.1Ni11 [his property be the buyer's primary ❑ 3. Homestead
residence? Provide mmplete address of primary , nergy Heating/Cooling System
residence, induding county:
Dale St ❑ ❑✓ 5. Wind Power Device
ACdrca(NumberandSVeen) ❑ ❑✓ 6. Hydroelectric Power Device
Oakland Ciri IN 47660 Gibson � Q 7. Geothermal Energy Headng/Cooling Device
Ciry, Smce Z/P Code Counry
� � 2. Does the buyer have a homestead in Indiana Co be � � 8• �s this property a residentlal rental property?
vacated for [his residence? If yes, provide ❑ ✓❑ 9� Would you like to receive tax s[a[emen[s for this
complete address of residence being vaca[ed, property via e-mail? (Provide contact information
including county: 6elow. Please see instructions%r more information.
Not available in all counaes.)
Addres (h'umber and Stree[f �{
Ciry,SmteZ/Plode lounro ��'/�/��O ' �v/�� O� �
Pn'marypmperryownermnruaname E-mail
Under penal[ies of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is [rue, correct
and comple[e as required by law, and is prepared in accordance with IC 641•5.5, "Real Proper[y Sales Disdosure Ac[". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homes[ead Deduc[ion is
being filed.) �
Signaareo(Bye�l ���� Signamreo(BUyer2/Spouse
IacnnK Hamhm> 01/14I2013__
Lat[SdigiCtofBuyerlDriver's Srote Last50igiLSO�SociolSeturiryNumber LastSdigi[sofBuyer2/SpouseDriver's Sta[e LastSDigi[sof5xialSecunty
Cicense/lD/O[herNum6er Number Giceue/lD/OrherNumber
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