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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
% c %S-c_ Closing Agent
Preparer of the Sales Disclosure Form Title
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.SELLER(S)/GRANTOR(S)71-,Y: C
Heather Bailey
Seller I•Nome as appears an conveyance document Seller 2-Name as appears on conveyance document
I 16aE _350S
•Addres(Numbe�odStreet) Address(Number and Street)
Pr!nc,Qnn ) ) 47670
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
' cclo_}/m1(`pplette.�aas red law,and is prepared in accordance with IC 6-1.1-5.5,.,Real Property Sales Disclosure Act".
Signature Signature of Seller
JUN Heather Bailey 1 7 2013
Printed Name of Seller rSian Date(MM/DO/YYil Printed Name of Seller Sian Date(MM/oo/YYY)
F.-BUYERS)/GRANTEE(S)_APPLICATION FOR-PROPERTY-TAX DEDUCTIONSiIDENTIFY AECITEMS THAVAPPLY -
Jeffrey W.McCullough Tara M.McCullough
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
5846 N.Co Rd.75 E. 5846 N.co Rd. 75 E
Address(Number and Street) Address(Number and Street)
Telephone Number Email
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
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 151 4.Solar Energy Heating/Cooling System
residence,including county: ❑
ra
1162E 350 S 5.Wind Power Device
Address(Number and Street) ❑ IS 6.Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
ig
❑ ❑ 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: below.Please see instructions for more information.
Not available in all counties.)
Address(Number any d 4
CilPCode County a • iitO CO I .5a3 Cal
ry,S teZ
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 b. nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note:
Spouse information,Soci 1 ty and Driver's License/Other numbers are not necessary if no Homestead Deduction is
I Iled.) / yv. (yy)C �l /`(� J l
gri eo/Buyerl�� JUN 1 7 2013 ///SignatureofBuyer2/Spouse U JUN 1 7 2013
Jeffrey W McCullough Tare M McCullough