Homestead_King INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
'DWREPARER',_ _ - .. - -_ _ _ _ .' _� 1' j _- _.
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(@REGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
.E.SEI)LER(S)/GRANTOR(S)° ----- — , ._ -- _.y_-_ . °_ _-- T 1_1,.__. -'- -
Coleen F Hinojosa now known as Coloen F Birch
xSeller I-Name as appea on conveyance document Seller 2-Name as appears on conveyance document
9(� E L � e 1I, r,(d Dr
Address Number and Street) Address(Number and Street)
)'
Address
; n<e-t-o0 NI 4-7L `70 —
_ 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 com le'te as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
X ( 'Q', _i - ��-o
Signature oJSeller I Signature of Seller
Spleen F Hinojosa now known as Coleen F Birr
Printed Name of Seller Sian Date(H.H/DD/YYYY) Printed Name of Seller Sian Date(H4/DDAYYY)
,F3UYER(S)/GRANTEE(S3:-APPLIGATIONFORPROPERTYTAXI)EDUCTIONS_IDENTIFY'ALL,ITEMSTHAT.APPLI.o _ __ _
Mark I- Kira m as p � E D
Bvyerl-Nvm¢os appears an conveyance document Bwer2.Name as appears on comeyanc oum t
230 S. Race St. I I
Address(Number and Street) Address(Number and Street)
Princeton, IN,47670 APR 1. 2014
Telephone Number ut E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TH254 Mfitinat-UN TY AUDITOR
YES 0 CONDITION I YES NO CONDITION
❑ 1.Will this property be the buyer's primary El ❑ 3. Homestead
residence? Provide complete address of primary ❑ Fl 4.Solar Energy Heating/Cooling System
residence,including county: ❑
230 S Race St S.Wind Power Device
Address(Number and Street) ❑ Fl 6.Hydroelectric Power Device
Princeton, IN,47670 GIBSON n Fl 7.Geothermal Energy Heating/Cooling Device
City,State ZIP' •e County
❑ E 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ is 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.
Not available in all counties.)
Address(Number and Street) I (��� ^�o
Mark A.King,Sr 3(0— I a'O1) --4Q''(�,3t IJC.L)-(:L()
City,State ZIP Code County
Primasy property owner contact name E-mail