HomeMy WebLinkAboutHomestead_Goldbach (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 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(dREGIONAL-LT-COM
City.State.and ZIP Code Telephone Number E-mail
:E.-SELLER(S)/GRANTOR(S) '-
Estate of Juanita R Dyer
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
15-15‘ S. Nk•tc Pjne SA.
Address(Number and Street) Address(Number and Street)
Tenet- f-{cwl c 1 d 11To3
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".
D. P e4:.- Or y-�-*'t ti -.....+ ,
Signature of Seller Signature of Seller
D Brian Dyer as Personal Reoresentative 6,)13) )9
Printed Name of Seller Sian Date(.N.N/DD/YYYY) Printed Name of Seller Sian Date(.e.v/DD/YYYY)
_F.BUYERW GRANTEE(SyT LAP,PLICATION.FOR•PROPERT.YTA.X:DEDUCTIONS ,IDENTIFYALL.ITEMSTHAT APPLYLS_ __ - __. _.
Kimberlee A. Goldbach
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
527 E 150 S
Address(Number and Street) Address(Number and Street)
Princeton, IN,47670
-
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORT ••.t.- . " -` --.ter L
YES.-_NO CONDITION YES NO CONDITION
C®,❑ 1.Will this property be the buyer's primary I a a -••• --
.' residence? Provide complete address of primary ❑ 0 4.Solar Energy HeAg, tiOystem
residence,including county: ❑ 0 S.Wind Power Device
527 E 150 S
Address(Number and Street) ❑ 5 6.Hydroelectric P i 'er.Ded c•5;
Princeton, IN.47670 GIBBON ❑ 5 7.GeotheU16 .y •7• ''l UUII nbRevice
City.State Zl Code County.
❑ �" 2.Does the buyer have a homestead in Indiana to be ❑ 8. Is this property a residential yenta 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.
Not available in all counties.)
Address(Number and Street) a 64a—QC4tQ O 5.°6•C, 7
Kimbedee A.Goldbach
City,State ZIP Code County
Primary property owner contact name E-mail