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Homestead_Ash INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.P:REPARER_
LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Form Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES,LLC
Address(Number and Street) Company
EVANSVILLE, IN 47708 812-468-8485
Ciry,State,and ZIP Code Telephone Number Email
,.E.SELLERS)/GRANTOR(S) ,. _.`.-_ _ ' • - i - - :. ___ .-.:
SCOTT HPICHFLBPCH SHFRRI HEICHFI BFCH
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
Address(Number and Street) Address(Number and Street)
City,State.and ZIP Code Ciry,State,and ZIP Code
Telephone Number Email Telephone Number E-mail
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".
Signature of Seller Signature of Seller
Printed Name of Seller Sian Date(MM/OO/YYlY) Printed Name of Seller Sian Date tMM/OD/YYYtl
,F.BUYER(S)/GRANTEE(S)_APPLICATION FOR'P,ROPERTY TAX
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OFT.I`.yS TA .
YES NO CONDITION YES NO CONDITION q ABA'' 1.Z\
0 ❑ 1.Will this property be the buyer's primary 1g ❑ 3.Homestead Y- \\ `AA`,,
residence? Provide complete address of primary ❑ 4.Solar Energy Hea[inn\)Cooling ys /
3--/..‘� �lf1 ,e /i'iluding county: ❑ Q S.Wind Power Device . 000°9.
r (frNuarbeerMeall in // r77.//g' n/ /sot) ❑ 7.Geothermal E Power F �10 �LN-
ctystateZI Code `f" Y' (n �j County
❑ gi 7.Geothermal Enetr ,4ii}ating/Cooling Device
0 ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 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.
Not available in all counties.)
Address(Number and Street)
Z4-19-19- /0 1 - ciao. /4,.7 - 0. , 1,,.
City,State ZIP Code Coun9.
Primary property owner contact name E-mail