Homestead_Smith INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
-DtPREPARER
Karen S. Creek Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main St,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville, IN 47708 812-421-4000 karen.creek{a�ieffbosse.com
Ciry,State,and ZIP Cade Telephone Number E-mail
E.SELLERS)/GRANTOR(S)`
Marcia Ellen Riley
Seller I-Name as appears on conveyancedocument Seller 2-Name as appears an conveyance document
,f33a t). tOS
Address(Number and Street) Address(Number and Street)
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".es.L.Lit-rea R.-545
I Signature of�r� Signature of Seller
Marcia Ellen Riley
15 g3'(4
Printed Name of Seller Eon DateJMM/DD/rUY) Printed Name of Seller Si Dap .4
F.BUYERS)/GRANTEE(S) APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY -
Richard E.SmitlO Cindy L. Smith JUN 2 P014
wryer dame as appears on conveyance document Buyer 2-Name as appears on conveyance document
332 S. 1050 E. 332 S. 1050E I •IVY Address(Number and Street) Address(Number and Street) IN r Veffifjr
Oakland City, IN 47660 Oakland City. IN 47660 GIBBON COUNTY AUDITOR
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES •O rn ON
\nrr
Li ❑ 1.Will this property be the buyer's primary El ❑ 3.HomesteaciTh
residence? Provide complete address of primary u 14 4.Solar Energy Heating/Cooling System
residence,including county: ❑ r-y Wind LSd 5. Ind Power Device
Address(Number and Street) [1 6.Hydroelectric Power Device
❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ e 2.Does the buyer have a homestead in Indiana to be El 8.Is this property a residential rental property?
ry,
vacated for this residence? Ifyes,provide ❑ 11011 9.Would you like to receive tax statements for this.
• complete address of residence being vacated, property via e-mail?(Provide contact information
7 "(rd.,: coTLryi below.Please see instructions for more information.
i► �Ly • r., asema .l .
A Nu .• .nd Street /
d•i AI; . LIA4i _ ' 4 ,d ,/1.14%. a‘ - ! 3 -l.1- 300- 000• a (05 - oa.6
City,State Z/PCode
Or cou•ty
Primary property owner contact name