HomeMy WebLinkAboutHomestead_Brain INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREP.ARERI T.— - - --—- -- -- - —r------ -- ---
Laura Rininger Closing Coordinator
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Regional Title Services, LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555
Ciry State,and ZIP Code Telephone Number E-mail
sEi:SELLER(S)%GRANTOR(S)L • —7—'777 - 3 —= _ ,_ . -
Christonher D Johnson
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document •
735 F Eisenhower I ane
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
a lete as require law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Signature of Seller
�"JI/s I/)) I I� Signature of Seller
Christooher D Johnson (/
Printed Name of Seller S(an Date(01/DD/YYYY1 Printed Name of Seller Sian Dote WN/DO/YYY11
1Y BU NTEE(SJEAP,P,LICAATION-FOR;PROPERTY_TAX,,DEDUCTIONS=IDENTIE.Y:ALLJTEMSiTHAT:APPLYI:
Andrea L. Brain
\Buryer l-Name pears on conveyance document Buyer 2-Name as appears on conveyance document
St.Apt. 210
Address(Number and Street) Address(Number and Street)
Chicago, IL 60601
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. s a a ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary ✓ ❑ 3.Homestead
residence? Provide complete address of primary v 4,Solar Energy Heatii1 ll g SygJrry
residence,including county: ❑ g� (�
S.Wind Power Devi
735E Eisenhower l ane
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson 1:1 5 7.Geothermal Energy H e ieRg4Clo levice
City,State ZIP Code County
❑ Fl 2.Does the buyer have a homestead in Indiana to be ❑ 5 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 9.Would you like to re /.e to�o: -•; < •r this
complete address of residence being vacated, property via to-131V- a(•e- ! .. information
including county: below. Please see ins uc PAIWYitd4AD!/6pxntion.
Not available in all counties.)
Address(Number and Street)
Cry,State ZIP Cade County
J/-i9d'J-/O/ 609. t ode-1
Primary property owner contact name &mall