HomeMy WebLinkAboutHomestead_Toth INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND
Address(Number and Street) Company
EVANSVILLE IN 47715 8124024553 CHRISTINAeREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
,*,.EsELLER[S)/GRANTOR(S)-_ _____._,i.._ S. .-.. -"- S•,'n •Nf±- `-
BRETT A SFIBERT
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1/d U y In S a oo5
A dress(Number and Street) Address(Number and Street)
r'lsl.45 /ccft -tt" Li 769$'
Telephone Nun: Ci.ice; ,Jk nLL [O-j, 1
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the I ' 1`, ` ,k J`,t
and complete as required by law,and is prepared in accordance with IC 6-1. L
aim- 4 5iP�r?,t I cni� 6 ,leer 1 , Ni
Signature of Seller ` ZO t3 Signature of Se! ,{�
RRFTTASFIRFRT `` \ Nil ---ri tr1
Printed Name of Seller Sian Date(M.M/DD/YYYn Printed Name 1
F:BUYER(S)%GRANTEE(S); ARPL.ICATION,FOR PROPERTY.-W/EDUCTIONSaIi \ 100 1
CHRISTINE M TOTH
Buyer I-Name as appears on conveyance d ment Buyer 2-Name
(c L \ :D.-. 00 0 -
Address(Number and Street) Address(Numbi
it `. •} I` (' (k'
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Telephone Numl •
THE SALES ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. ID1
•
YES NO CONDITION I YES NO �____..._..
❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county:
\t�\O Can+r
� , n ig 5.Wind Power Device
Addres umber and5[`reet) 1I /� I-��'�,.��� ❑ � 6.Hydroelectric Power Device
�1 inC ilf� `� ���t�1
CI; bJOaLJ ❑ Il 7.Geothermal Energy Heating/Cooling Device
City, to ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 151 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
X ,, including ounty: below.Please see instructions for more information.
c(� ) 55 Lk) nNot available in all counties.) ,. / �r
c:16�(ress(Number and Street)I --7 ,r� 6��Y/„,./03_006. 6„zz —Vole
V (LLa\suiI1t-P -1-OLPto(`j� -tui-5nr1 !SfffTTTTINEMTOTH
Ciry,State ZIP Code County
Primary property 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
beein, filed.)
Si r\-er .Q 12\aliv,/
Signature of Buyer! Signature ofBUyer2/Spouse
CHRISTINF M T(1TH At�-r(r CO
Number License/ID/Other Number