Homestead_Hale •
INDIANA SALES DISCLOSURE FORM .il)F ID: Page 2
I). PREPARER
Chris Ferguson Closing Agent
Preparer of theSales Disclosure Farm Tide
501 Main St.Suite 101 Bosse Title Company
Address(Sumner and Street) tom pang
Evansville, IN 47708 812-421-4000
City.State.and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)
Rita a3n
Seller 1-Name as appears on canve,vnce document Seller 2-Name as appears on conveyance document
4387 L 16.7own 7d
Address(Number and Srreet)) Address(Number and Street)
7rince4-t n. �2A1 447470
•'
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 pie e as req 'red by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Sign re73(Se1r] Signature of Seller
Rita Dougan 8-4- /.3_
Printed Name of Seller Sion DoteL4.e/OD/YYYtl'1 Printed,Name of Seller Sian Date Lww/DDnttfl
F.BUYER S GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS_IDENTIFY ALL ITEMS THAT APPLY
Thomas A.Hale
uy err-.r as appears on conveyance doe men , Buyer
Name as appears on conveyance document
'Address(Number and 5treet)3 / �1 / Address(Number and Street)
OGei(A-.f(l1L/e /itco{ d'a ivy c 7465
Telephone Number Email
THE SALES DISCLOSURE FORM MAY DE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
(YES- -NO—CONDITION- I YES 1,50
yp 1.Will this property be the buyer's primary ❑ 3.Homestea"3
residence? Provide complete address of primary o 4.Solar Energy Heating/Cooling System
�side'1 1-va'cRd ❑
/ 3"g 7 Q, r d'' 5.Wind Power Device
CAddress eta ❑ SI 6.Hydroelectric Power Device
1A//•7/-ccto4/ /,1t/ Y/670 //SA
C Citv'State ZIP Code CCaua ❑ 7.Geothermal Energy Heating/Cooling Device ,
ry�
❑ ❑ 2.Does the buyer have a homestead in Indiana to be El ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 151 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.
Nat available in all counties.)
Address(Number and Street) ) C,/
City,State up Code A6 -4�t -ot /am -000. SoSto a7
ounry
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 information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
.aolitit...... traL ;- 6 -/
CSiynoture of QCt113
S.ynature of Jr.}er7/Sparse
Thomas A Hain
Number License/ID/Urher Number