HomeMy WebLinkAboutHomestead_Webb INDIANA SALES DISCLOSURE FORM SDF ID: 2014 Page 2.
D. PREPARER ' J'.
Teresa S. Holifield Escrow Officer
Preparerof the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812) 425-0055 tresa@swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Mary J.Weiss
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
110 S West St
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
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 req red by aw, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
ru4p . 1 W1
r nature of Seller Signature of Seller
Mary J. Weiss L/ 8/22/2014 8/22/2014
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Edward N.Webb / i
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears n ya a tlo m nt
2777 E State Route 62
Address(Number and Street) Address(Number and Street)
Boonville, IN 47601 Ai I(, 2 6 2011
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.GiliStV. DPN1}WWbfill 'LY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary El ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence,including county:
❑ El 5. Wind Power Device
110 S West St.
Address(Number and Street) CI 121 . '
6. Hydroelectric Power Device -
•Haubstadt, IN 47639 i Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ El 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)/� /���
Address(Number and Street) .; _it)}3) 3-C](-�_ I'/2- '1" i-7'
City,State ZIP Code County Primary property owner contact name (/(,,(/ J v`/ E-mail