Homestead_Campbell INDIANA SALES DISCLOSURE FORM SDF ID: 2013 Page 2
D. PREPARER
Teresa Holifield Escrow Officer
Preparerof the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 tresa@swinland.com
City. State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
James D. McRoberts Betty J. McRoberts
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1366 E.Taftown Rd. 1366 E.Taftown Rd.
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 Princeton, IN 47670
U ,er 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 I , and is prepared in accordance with IC,.1-5 -, -e. .Prope les Di lo ure Act".
A .
Ail
in A 9 .1 1 - / . 9 .1111.•__ 7 a
( S•nature of eller Signet re of Seller
'1 ames D. McRoberts 8/6/2013 Betty J. McRoberts 8/6/2013
Printed Name of Seller Sign Date(MM/DDNYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Matthew G. Campbell
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
1346 S. Lookout Mountain Drive
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS F• •ROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION Y NO CONDITI• •
qp El 1. Will this property be the buyer's primary Q O. 3. Homestead
/\ residence? Provide complete address of primary ❑ li 4. Solar Energy Heating/Cooling System
residence, including county: �,(
1366 ❑ R 5. Wind Power Device
366 Easi Taftown Rd.
Address(Number and Street) ❑ %1 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ 10 7. Geothermal Energy Heating/Cooling Device
City,Sta TIP Code County ❑ 8. Is this property a residential rental property?
❑ H 2. Does the buyer have a homestead in Indiana to be ❑ 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) c ? p I d—0S--(4W —CO I ,Y39 _T,J'
City, State ZIP Code County Primary property owner contact name •7 W 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
inform '�i , S f, al Se- •i iver's LicenselOther numbers are not necessary if no Homestead Deduction is being filed.)
Bu r 1 r�� Signature of Buyer 2/Spouse
Matthew G. Campbell 8/6/2013 8/6/2013
License/ID/Other Number