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HomeMy WebLinkAboutHomestead_Gillum INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER - - - - - Stacey Salzman _ ___ _ ___ Closer Preparer of the Soles Disclosure Form Title 4962 Lincoln Ave. First AdvantageTitle Address(Number and Street) Company Evansville, IN 47715 812-490-8485 theteamf@firstadvantagetitle.com City,Stare,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTORU . , - , - _ - ._ - - - ._ . Megan Renee Westheiderman - Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 11 West Red Bank Road Address(Number and Street) Address(Number and Street) Fort Branch IN 47648 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". r ( (0n 012 i weesk'x Jd,u-(rnnih Signature alter Signature of Seller Megan Renee Westheiderman 8177/7014 _ Printed Name of Seller Sion Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/oa/YYYY) F.BUYER(S)/GRANTEE(S)-APPLICATION-FOR PROPERTY TAX-DEDUCTIONS=-IDENTIFY ALL•ITEMS:THAT-APPLY , Bradley S Gillum Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 701 Forest Park Dr Address(Number and Street) Address(Number and Street) Newburgh, IN 47630 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUC TION S FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THPP y Jmail YES NO CONDITION I YES NO CONDITION JJJLLL 1IIMlII , ❑ 1.Will this property be the buyer's primary ❑ 3. Homestead SEP 18 2014 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System 1 j wall eric I clu1di c-aunty: ,, ( c ❑ Q 4 �-fC S.Wind Power Device J� j d, dose( ,er nstreet) I ' `b4 %l ❑ 6.hydroelectric ftgo friar AUDITOR e eZ J1 '{ �'iYr"t" ❑ ❑ 7.Geothermal Energy Heating/Cooing Device City,State ZIPCode County ❑ ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ z 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) City,State ZIP Code County a Primary property owner contact name E-mail