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Homestead_Mann
IINVIANA DALC VIJLLUJUHC rUHm JVr IU: Na e;ltf D.'PREPARER._ _ e riselasure Form Title ve Regional Land Title Street) Company Evansville, In 47715 E -mail Gacy D Stamps Jr Shcerl -Na pasappemson ronveya eda�vment ,nZ`M�Saef S I / Cig ;State, and7JP Code less -A Starnes Seller 2 -Name as appeano vey nce document /is ��iarC i %f Address(Number nd Street) �n _q 1q i � � O [V IS 3$S_lD/o Ciry, Statg and ZlPlod¢ Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as required bylaw, and 1 prepared in accordance with IC,6- 1.1 -5.5, "Real Pro rty Sales Disclosure Act". Signature ofSef v Signs reofSeller r 3) VJ / ed meo Seler /O D e r\ P l Printed Name ol Sian Da rmx1DDhTm .F.BUYER(SI/ GRANTEE (S) -APPLICATION , FOR -PR PERTYTAXDEDUCTIONS- IDENTIFY -ALL ITEMSTHATAPPLY - -. ' - Buyer I - Name as appears on conveyance document SD- S 1�-t, f- S4 Address (Number and Street) -Y-76 y; Smte, and ZIPCode 1 Buyer 2 - Name as appears on conveyance document Address (Number and Street) City, State, and ZIP Code THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. ❑ 1. Will this property be the buyer's primary \ residence? Provide complete address of primary � � ( �, Y l ie`�. n ce� Ig ddren �M1'umber and Sneer) 1 _ �yl 6` �1�/ Y '� <)5 City, Store County ❑ $ 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide complete address of residence being vacated, including county: Address (Number and Street) Ciry, Store ZIP Code County YES NO CONDITION ❑ © 9. Would you like to receive tax statements for this property via e-mail? (Provide contact information below. Please see instructions for more information. Not availabl ina_ counties) Primary orooerty owner contact name E -mail Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act". (Note: Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is being filed.) — Printed Legal Name of Buyer 1 Sign Date (MM/DDIr" ili Last 5 digits of Buyer l Driver's State Last 5 Digits of Social Security Number License /ID /Other Number Signature ofBuyer2 /Spouse Printed Legal Name of Buyer 2 1Spouse Sign Date(.NM/DD/YYYYI Last 5 digits of Buyer 2 15pouse Driver's State Last 5 Digits of Social Security Number License /ID /Other Number