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Homestead_Douglas (12)
• INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 Laura Rininger Closing Coordinator Preporer 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 E SEL•LER(S)%GRANTOR(S) -- - - _ , _ - _ _ - , .1 I awrenre R Burg Seller I-Name as appears an conveyance document Seller 2-Name as appears on conveyance document 5132 S 700 W 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 require�}py'j w,,,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". ,afire of Seller -' Signature of Seller Iawrenre R Burg 6/19/2014 Printed Name of Seller Skin Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/Ym') F,:B DYER(5)%GRANTEE(S): APP,LICAT10NFORPROPERTYTAX.DEDUCT!ONS_IDENTIFYALCITEMSTHAT APPLY Blane A. Douglas Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 13331 Wildflower Dr. Address(Number and Street) Address(Number and Street) Evansville, IN 47725 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 NO CONDITION JUN 2 3 2014 5 ❑ 1.Will this property be the buyer's primary j9 ❑ 3. Homestead residence? Provide complete address of primary ❑ 5 4, Solar Energy Heagl,thlikstem residence,including county: ❑ 10 5.Wind Pov9dpi i POUNTY AUDITOR 5132 S 700W • Address(Number and Street) ❑ 0 6. Hydroelectric Power Device Owensville, IN 47665 Gibson 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code county ❑ 5 2. Does the buyer have a homestead in Indiana to be ❑ 0 8. 1s 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. Not available in all counties.) Address(Number and Street) ac- ` -& `- 40©_ 600704i _Da` City,State ZIP Code County Primary property owner contact name E-mail