Homestead_Smith (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.Andrew Nestrick Attorney at Law
Preparer of the Sales Disclosure Form Tide
20 NW Fourth Street Bambercier, Foreman, Oswald& Hahn,LLP
Address(Number and Sweet) Company
Evansville, IN 47708 (8121425-1591 anestrick(ibamberoer.com
City,State,and ZIP Code Telephone Number E-mail
E:SELLER(S)/GRANTOR(S) -. . • ,_
•
Lois Smith
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
Slav l Est Ali IZaht-fc Rai
Address(Number and Street) Address(Number and Street)
Pelee. IA) t/7(, Q
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".
C;;*-t kn.
Signature of Seller / c, 1`1 Signature of Seller
6
I mis Smith 4- 5- 1 -
Printed Name of Seller Sign Date(MM/DO Y1'Y) Printed Name of Seller Sian Date MA
F.BUYERIS17GRAANNTEE(S)'L APPLICATI ON'FORPROPERTYTAXDEDUCTIONS=IDENTIFYALLIT T�3A ApiP(Iy�J(` -�.
Caleb E.Smith "1 gg (I
c4-NOme-rappea.a on conveyance document Buyer 2-Name as appears on conveyance document
3104 East McRoberts Road II IN 16 2014
Address(Number and Street) Address(Number and Street)
Patoka. IN 47666 .. .
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
❑ 1.Will this property be the buyer's primary ( `-' ❑ 3.Homestead
residence? Provide complete address of primary ❑ M 4.Solar Energy Heating/Cooling System
residence,including county: ❑
ig S.Wind Power Device
3104 East McRoberts Road
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Patoka, IN 47666 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ B.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.
Address(Number and Street) 1
Caleb E.Smith aX, -05-5 7 - 01/ - 000. 7 0), A •O/
City,Stare ZIP Code County
„ re.,,v,.cyotenenontaa name—.---___ E-mail_.i