Homestead_Osborne w
INDIANA SALES DISCLOSURE FORM SDF ID: Paget
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'DiPREPARERI -- - - -
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I Karen Creek Closing Agent
Preparero/t eSala Daciozwe Form Tale
I 501 Main Street Bosse Title Company
Address(Number and Sent) Crxvpmry
Evansville,IN 47708 812-421-4000
City.State and ZIP Code Telephone Number E-metl
I iESELLER(SI/GRANTOR(S)i
Barbara A 'Wes Per Pen Fstate of Gary L Kay - - ---.—_ -__-. _..
Istk.I-Naweas appears go rmrryence document Seller 2-Name as appears on mu,tyaaee Ma...nt
I . 301 M ej iwood Dr-
I Add (Number Sant) Address(Number and Stint)
I Al 14 113 an y ni ? 150
1
Telephone Number Email
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
j n om etc as r tree law,pp s repared in cord y with IC 6-1.1-5.5,'Real Property Sales Disclosure Act".
1( A .
Signature a/Sdkr / S Mart of Strike
Barbaa AlePerRyFstale of w E
stinted Name of Seller Sian Date(MM/DD/I1Y11 Printed Name ofSelkr Sian Date isamO YYM
.F:BUYER(SVGRANTEE(S)=APPLICATION FOR PROPERTY,TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLYL, _- ..- .
Stanley Osborne ) -
Pea on renveswe docammt Dyer 2-Name at appom on taarey✓ue document
1 11971%vume.r n and Q iOL4c Address(Number and Street)
I
Telep*aae Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TINS PROPERTY.IDENTIFY ALL OF THOSE TIC$
YES NO CONDmON YES __NOR—CONBrilQN 11
I ❑ 1.Will this property be the buyer's primary �m ❑ 3.Honincea •
residence? Provide complete address of primary id 4_So ar Energy Heating/ yng Sy-
/ DD rAe�sidence,including county ❑ ❑ �I 1 OLU1,7
l/Oi s 13ou..k.EVA-&b Pt at 5.Wind Power Device
Addrm(Number and&teed,i,__,, /+ ❑ 6.Hydroelectric Power D ice PRIMCCT°NI l,✓ 47470 GlQSON ❑ 7.Geothermal Energy Hl g vrn
❑ry re ZIP Code Canty
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this propert�a!#S3 ri�52W*Eipt'&jQ R
F T ❑ ❑ 9.Would you like to receive tax statements for this
I vacated for this residence? If yes,provide
1 complete address of residence being vacated, property via e-mail?(Provide contact information
i inducting un below.Please see instructions for more information.
I L 2. s ,Ui .v L ¢. - l-
Marto(NamDera. Street) CIA ...a j j f?RrA&EjO.ti �� 051 -60 3. A3 te-oa8
eiry State
ZIP Code C •
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