Homestead_Smith (19) z
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
ID.PREPARER I
Laura Rininger Closing Coordinator
Preparer of the Sales Disclosure Form .. Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services, LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555
City.State,and ZIP Code Telephone Number E-mail
1E,SELLER(S)/GRANTOR(S) I
I inda Pearl Lowe
Seller!-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6854 W 450 S
Address(Number and Street) Address(Number and Street)
Owensville IN 47665
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 rreJquired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
�,,(��(w y ..l.e Yiuo-e-
tgnaturre of Seller Signature of Seller
I inda Pearl I owe 6/6/2014
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
IF.BUYER S GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL I : A'i ' ) ' • I
Derek C. Smith .�
Sayer!-Namrns appears on conveyance document Buyer 2-Name as appears on conveyance document
613 N, Hart St. JUN y 2011
Address(Number and Street) Address(Number and Street)
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 0--CONDITICLN.,
Y ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead—)
residence? Provide complete address of primary ❑ U 4.Solar Energy Heating/Cooling System
residence,including county: ❑
6854 W 450 S 5.Wind Power Device
Address(Number and Street) ❑ Fl 6. Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
❑ J 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 ❑ 0 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.
s • • e' e. - in all counties.)
Address(Number and Street)
)6, —lo - 36, . 4too - 00o .56,3 -01/
City.State ZIP Code County "
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