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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
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4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company I
EVANSVILLE, IN 47715 812-402-4553 CHRISTIN/WREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
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,B SELLERR(S)/GRANTOR(S)'`2h.. :-`. -:.-a,.. — )-k r 4 ,.. ^'
..�; _ ,. _ :7i - _=T 72 '^ -'_ _ .-,.. ".
Casey Canny!. I :
Seller I-Name as appears on conveyance document Seller Z-Name as appears on conveyance documen:
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20? F Gibson Street i
Address(Number and Street) Address(Number and Street)
Haubstadt IN 47639
Telephone Number I 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".
SignaC 'o Signature of Seller
Casey CaringPr 09/3012013 '
Printed Name of Seller Sian Date fM.N/DD/YYYf1 Printed Name of Seller I Sian Date(MM/DD/YYYn
•F:BUYER(S)/GRANTEE(S):=APPLICATION FOR PROPERTY:TAX DEDUCTIONS-.IDENTIFY.AIEITEMS THAT;APPLYiTic .�.
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James B. Short Simine Short .
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
1691 E.Autumn Ridge Dr. 1691 E.Autumn Ridge Dr.
Address(Number and Street) Address(Number and Street)
Haubstadt, IN.47639 Haubstadt, IN,47639 _
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 12 ❑ 3.Homestead in 1
residence? Provide complete address of primary ❑ 0 4.Solar Ener e n /Co S i
residence,including county: 5.Wind Pow Del
1691 E Autumn Ridge Dr a I
Address(Number and Street) 0 6.Hydroelectric Pm!e1gelic �3
Haubstadt. IN.47639 ❑ 12 7.Geothermal Ene tine ooling Device
City,State ZIP Code
County
❑ El 8. Is this property siden 'al r operty?
❑ E-- 2.Does the buyer have a homestead in Indiana to be �
vacated for this residence? If yes,provide ❑ 0 9.Would you like tementts for this
complete address of residence being vacated, property GISCIlinct Tie ecSAIP#orm adon
including county: below.Please see instructions for more information.
Not available itll counties.)
Address Number and Street n/ II(( �(yy�� ((�����/� �,/QQ//
( ) James B.Short 20 a3-{t porn-l:t. . /UG Li
Ciy,State ZIP Code Count I Primary property owner contact name E-mail