Homestead_Bishop INDIANA SALES DISCLOSURE FORM SDF ID: 2012 Page 2
D. PREPA.RER
'.!/250. S . 4411(-1 ao_cg t -os I N 6 A-6,eyvr
Preparer of the Sales Disclosure Form Title
.d
SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
dress(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
T Corp., an Indiana corporation
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
(2.4411 Oat- ) 3 00 Soi_ -h
Address(Number and Street) Address(Number and Street)
,(IN G4r s+-cd+ _710 LOG 37
Telephone Number E-mail
Under p- al .-s of perjury, I hereby certify,that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
and • plet- as required by and is prerpare In accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
K`riot r •• eller -/ Signature of Seller
dbuk-I- li1( I M(o ti /2/3/iz
Printed Name of Seller ' Sign Date(M /YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Mary Jo Bishop
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
563 . 1). e. 814- iwz
dress(Number and Street) _ 3 Address(Number and Street)
)(ct ulOs kc-1 1-, JIJ Li 76, �i
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.
Y S NO CONDITION `0 CONDITIO
❑ 1. Will this property be the buyer's primary I$ ❑ 3. Homestead
residence? Provide complete address of primary ift ;. - _, , - -ea Ing/Cooling System , S
residence,including county:
702 East Edinborough Court ❑ ® 5. Wind Power Device
Address(Number and Street) ❑ , 6. Hydroelectric Power Device 1�h/
Haubstadt, IN 47639 1 Gibson' ❑ Citl 7. Geothermal Energy Heating/Cooling Device
City, StatZIP Code County ❑ LA 8. Is this property a residential rental property?
❑ Lj�/ 2. Does the buyer have a homestead in Indiana to be ID eit 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) (-; („_ 1 9 3 / co .Cpp. 839-0c5
City,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 filed.)el-
nature oguf�r 1 , / Signature of Buyer 2/Spouse
Mary Jo Bishop /2-b /f L
License/ID/Other Number