Homestead_Anderson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER . ' - _ . .. : -
Chris Ferguson Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main St. Suite 101 Bosse Title Company •
• Address(Number and Street) Company
Evansville, IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) - -
Rodney Payne
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
Zaa S. o
(Number and Street) . 1/74, 9 / Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a plete as re'rreddy law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Se r / Signature of Seller
Rodney Payne 07/29/9014
Printed Name of Seller Sign Date(MM/aa/m•Y) Printed Name ofSellerI J DDATYY)
F.-BUYERS)/GRANTEE(5):-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEM PL . -
Lora J.
e-N 2014
Address(Nuummbber and Street) Q Address(Number and Street)
�
:•II•
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
12 ❑ 1.Will this property be the buyer's primary . igi ❑ 3.Homestead •
residence? Provide complete address of primary ❑ h,/i 4. oar eating/Cooling System
residence,including county: ❑
5.Wind Power Device
203 S Main St.
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Ft. Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ [>i 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 ❑ TA 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 a •' •• • • • ••
Address(Number and Street)
,26 -/8-/3 - y0 V-oao. r y4, -o ).- 6
City,State ZIP Code County •
'marypropeRY owner contact name -mail