Homestead_Mitchell INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
• TPREPARE:I 7T - _' - __ 77,7- -
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LANA C. HARPER CLOSER ---_� -� s- -� --
Preparerof the Sales Disclosure Form Tide
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
E:SELLER(S)/GRANTOR{5) -- __. ----Ilia- _-
TRICIA K IVERSON A(K(A TRICIA K VENDRELY
Seller l-Nam s appears on conveyance document Seller 2-Name as appears on conveyance document
.5I3E. AriCer.
Address(Number and Street) Address(Number and Street)
faanhtINLV-Alpil
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 b 'law,an is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
q .
Si nature of Seller Signature of Seller
IrICIa, I.<-IvVson f4/48. lverscn 6-/a-l3
Printed Name of Seller Sign Date(MM/OD/YYYY) Printed Name of Seller Sian Date(MM/UD/YYYYI
F:BUYER(S)/GRANTEE(S) APP,L(CATIONFORPROPERTYTAXDEDUC-TIONS-IDENTIFY-ALL'ITEMSTHATAP,PLY'_ _,_
DANIEL MITCHELL
Byer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
3aq S. +h Ave, 4p-f17
Address(Number nd Street) Address(Number and Street)
�►nre , I N 47(P70
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
!IA El 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ TA 4.Solar Energy Heating/Cooling System
residence,including county: Q 5.Wind Power Device
IUD 5 - (U1Ilard <Sfr/'zap-f ❑
re (NRber and
Q1r14Y 1 10 476`Y� /+ 1105b/r1 ❑ 6.Hydroelectric Power Device
City, re,Zll/'P7Cad(e �-� County
❑ 0 7.Geothermal Energy Heating/Cooling Device
❑ V9, 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 ❑ 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: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code county x(-01948- 303-OCO I a-ba ,
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'- t -t ation,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
beiges: fi(lleeedvdA7 r
4Jg5 eo(Buy'1%%! � I Signature of Buyer2/Spouse
tan}e.Y B. in kh-Il (o-R-/3
Number License/ID/Other Number