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HomeMy WebLinkAboutHomestead_Vaal INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 1 D.PREPARER Jeffrey H. Bosse Closing Agent Preparer of the Sales Disclosure Form Title 501 Main St., Ste 101 Bosse Title Co Address(Number and Street) Company Evansville, IN 47708 812-421-4000 ieff.iosse.2(Wieffbosse.com CO;State.and ZIP Lode Telephone Number E-mail F.SELLERS)/GRANTOR(S) 1 . . _ -."7.'4'7.74::::,.. a,' _ -., r.y - Paul F Brown Sr Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 216 S Vine St Address(Number and Street) Address(Number and Street) Haubstadt IN 47639 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 c plete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". L5IaF JUN 2 4 2013 Signature of Seller • VAI . A Qndaa $n. Printed Name of Seller I Sian Date(MM/aD/YYYI) Printed Name of Seller Sian Date lx.v/oo/rrYll F.BUYER(S)/GRANTEE(S),IrrAPPLICATIONLFOR PROPERflT DEDUCTIONSSIDENTIFY'ALL ITEMS THAT APPLY. ' ,.. _ 1 sr Jecuned 1c J0.,ciA Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 1301 S. 200 W Address(Number and Street) Address(Number and Street) Princeton,IN 47670 THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION I YES NO CONDITION Q ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System residence,including county: ❑ 5.Wind Power Device Address(Number and Street) ❑ 151 6.Hydroelectric Power Device City,State ZIP Code County ❑ 0 7.Geothermal Energy Heating/Cooling Device ❑ El 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?gl 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) �1 /y, City,State ZlPCOde County -coo •3 2 --09 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 requi ed by law;and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". (Note: Spouse info mation, ci Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is b g filed ✓�1 4 5 nature of Buyer]. LYE/ Number License/ID/Other Number ) D