HomeMy WebLinkAboutHomestead_Cooper INDIANA SALES DISCLOSURE FORM SDF ID: Page 2•:D.PREPARER'_:--:.._:2 .;, _ �. _ _ 1T=_._ --- "`_i, :_
JEFFREY H. BOSSE VP
Preparer of the Sales Disclosure Form Tale
501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 (812)421-4000
City,Slate,and ZIP Code
Telephone Number E-mail
KFJ I FN C HIGGINSON RACHFJ I F I HIGGINSON
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
rIZZY5— S $rodRt Pr 5a.rn.L
'Address(Number and Street) Address(Number and Street)
f/a•lb617001f. IN '/763 9
'
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 corn I lete as required by law,and is prepared in accordance IC 6-1.1-5.5,"Rea Property Salle(s�DDiisclosure Act".
LSignaotre o(Set •, [ Sig azure a �O\-/6 /
KELLFN C HIGGINSON C'1 (( 3 RACHFJ 1 F I HIGGINSON A if(((e(j
Printed Name t Sian ate1.LM/DO/MY' Printed Name of Seller Sian Date IN /DD/Y1YY)
. R(S)/GRANTEE(S)::: '-P,LICATION.FORPROPERTY_TAX-DEI ' ' ` z r' • ALh1TEMSTHAT:APPLY - _
CHRISTOPHER CsOPE" `
t MILY HIRSCH
Buyer I-Name as a•..-;,•-- , conveyanr document W'�- 2-Name as•• -• on conveyance document
Telephone Number
THE SALES DISCLOSURE FORM MAY RE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
IFS NO CONDITiON I I t
Q 1.Will this property be the buyer's primary El III . III" '•I
residence? Provide complete address of primary 0 2 4.Solar Energy Heating/Cooling System
'1 ,
residence,iinglluuddinngg county: �5.Wind Power Device
tO3 W '"�— El �6.HydroelectricPowerDevice
Adr�c (Number dStr )
- C�, .0 416 [�7.Geothermal Energy Heating/Cooling Device •
City,Stare ZIP a tounry ❑ Er .Is this property a residential rental property?
2.Does the buyer have a homestead in Indiana to be q.Would foil like to receive taz statements foi't}iis. - -
vacated for this residence? If yes,provide
complete address of residence being vacated, property via e-mail?(Provide contact information
below.Please see instructions for more information.
including county: ^
Not available in it-counties...))' /�/�/yM
Address(Number and Street) ' 16- /�(1-ifO7_ 00 0 • •W V•007
Ciry,State ZIP Code County !i/ ./IIIVVV E-mail
Primary property owner contact name _
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.
bein file /1 c ill 1 .I�LLA e>c
ianature NfB ri