HomeMy WebLinkAboutHomestead_Breidenbaugh • , INDIANA SALES DISCLOSURE FORM • SDF ID:_-. Page 2
_D.,P.REPARER; e -- -j__ -. so_—t ' 1. -f r- _ -
LANA C. HARPER CLOSER
Preparer of the Soles Disclosure Farm Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES, LLC
Address(Number and Street) Company
EVANSVILLE,IN 47708 812-468-8485
City,State,and ZIP Code Telephone Number E-mail
`ETSEIXER{S)%GRANTOR(S).. ,r-_;: _ - T'- tr a>= ' T- T .-<... -_ - - ,T7-" ---=7 _ -,.- t. ^s='__ _
KIMBERLY Y RLAIZE
Seller I-Name as appears on conveyance document Seller 2'Name as appears on conveyance document
7S-80 e? y�� �a FILED
Ad��d���(h'u�m'`rand Street) Address(Number Street)
Ai, ,,.. �tl Y76
Telephone Number E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowle a and el' js.tFUe,correct
and co t s require by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Prop osure Act".
�j„ �/, jQ'a.� GIBSON COUNTY AUDITOR
i ure ofSller Signature of Seller
h/m&r� 1y/ 6alit 5-s l3
Printed Name of Sell / Sian Date IMM/oo/YfyJ Printed Name of Seller Sian Date(MM/DO/1YYn
tit . —�--
tEBUYER(S]�GRANTEE{S),ARP[.ICATION:FOR'P.ROPERTY.TAX-DEDUCTIONSIDENTIFYALLITEMSTFUIT.%AP,PLY L._ - , ,- -..
MITCH BREIDENBAUGH MARISSA A. BREIDENBAUGH
Bu er I'Name as appears ortynryanre document Buyer 2-Name as appears an conveyance document
1I t LI {t.) . 614 l f r d CLP Q_ u Liu! w. G(a nct q
ess(Number and Street) A ress(Number and Street)
1 L -1 n II° 57670 (I nro-l-L) l , I N -17(01
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary (Ti ri 4.Solar Energy Heating/Cooling System
residence, clu.'•: county:
�.JdQ loP f� • a ❑ ri 5.Wind Power Device
r pjiu! eer /tJ ee J, I 517/ 7o /,/ O I ❑ 6.Hydroelectric Power Device
Cm m[eZlPlade !/lJ So CoOA ❑ 0 7.Geothermal Energy Heating/Cooling Device
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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: elow.Please see instructions f. ----e • -. ormation.
- l�I &5f A 1 f/,n,d li(t S.I. Not available in all counties.) do
fir ess/Numbers dSweet)
e nct+on� 41 �767� (962 -la-Ib-aoo -oo\. sgi-oa
iry.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
being fi�-e�d. [.��
� �%��� 5— $") 3 unlace 6(9_1 as • • 01
- Signature of Buyer f y Signature of Buyer2/Spouse
ml7lp aRCJiYiJBRaQN 5-9-/3 /1�lelssP P. ARE7Da &2 /' 6-1-8