Homestead_Lankford (2) • ..
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
ID.PREPARER
Chris Ferguson Closing Agent
Preparer of the Soles Disclosure Form Tide
501 Main St-Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville. IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E:SEELER(Sl/GRANTOR(S)' - - . _ ':.r '•;'• .s/rs=- , /., ..a ,. ssj.,, •-;^ _ _ .-, .•:z` ,C_,.:.
G Burton Evans Lori '"^4„ ""'id-
Sel! I-Na as appears on conveyance document Seller 2-Name as appears on conveyance document stls-
Cdress(Numbb_ran Street J4 if, 3,9 Address(Number and Street)
Telephone Number 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 equired by law,and is prepared in accordance with IC -}.1-5.5,/ReadProperty Sales Di closure Act".
✓Lim— nature On( 0 ca /\\
‘Sigbature Of Seller-, ofSeller
S; Burton Fvans 04/05/2013
Printed Name of Seller Sign Date(M.m/DO/YYY) Printed Name of Seller Sian Date(MM/DD/YYYYI
F)-BUYER(S)%GRANTEE(S);='APPLICATION FORPROPERTYTAX:DEDUCTIONS;IDENTIFY'ALliITEMS-THAT:APPL•Y„ „f t. ,n+"- - =:
Lori Lankford
Bu erl Nam cars an conveyance document Buyer 2-Name as appears on conveyance document
5641 W 900 S
Address(Number and Street) Address(Number and Street)
®Owensville,IN 47665
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES ^ CON TION
SI ❑ 1.Will this property be the buyer's primary l 0 ❑ 3.Homestea
residence? Provide complete address of primary k ❑ 12 4.Solar Energy Heating/Cooling System
residence,including county: ❑
5641 W 900 S 5.Wind Power Device
Address(Number and Street) - ❑ 12 6.Hydroelectric Power Device
Owensville, IN 47665 Gibson
State ZIP Code County ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,
❑ IA 2.Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes,provide ❑ TA 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
r•• a, a in a counties.
Address(Number and Street)
0Z4 - /Y J0 - yoo -tot. B7s-O),$
City,State ZIP Code Counwnrr
contact name
•
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 fl d.)_
X9O'\a 0.1 'llkck_
nature oJBUyer11 Signature of BuyerZ/Spouse
®Lori I ankfnrd 04/05/7013
-------- ' Number License/ID/Other Number NR\