Homestead_Jerrell INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Drl REPARER
•
Stephanie Miller Closer
Preparer of the Sales Disclosure Form Title
4962 Lincoln Ave. First Advantage Title
Address(Number and Street) Company
Evansville, IN 47715 812-490-8485 theteamefirstadvantacietitle.com
Ciry,State,and ZIP Code Telephone Number E-mail
,E.SELLEfs]/GRANTOR(S)' a --`' _ _
Chase I ankford
Seller)-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
601 South Stormont Street
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,I h- - •y certify th this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn•.ete as requir• : • . ,and • ared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Chase I ankford 10/9/2014
Printed Name ofSeller Sian Date(•M/DO/YYYI) Printed Name ofSeller Sign Date(MM/DD/YYYY)
F..BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY:TAX DEDUCTIONS-!IDENTIFY'ALL 1TE? H JT P,PL
Cis M Jerrell (—Christine R J el I
�Bu - ppeors on conveyance document Buyer 2 Name as appears on conveyance document
13 W1 I -Nl)ll same of T 21 2014
Address(Number and Address(Number and Street)
j nttian IN 1101 D
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YFS NO CONDITION YES NO 'QNDITIO
[ ❑ 1.Will this property be the buyer's primary CQ' ❑ 3.Homestead
residence? Provide complete address of primary <�yl- 4.Solar Energy Heating/Cooling System
r d�nce,includng3unty:
S• rro i
❑ 19 S.Wind Power Device
regress(Number and Street) ', /,�. I ❑ 0 6.Hydroelectric Power Device
1"f-In(P-bN I bl "11tp1Q Al 17•
yJ ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State Z Code County
❑ (" 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 ❑ 17 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)
- — IA - 07 - Yoy-oat P90 - oA :
City,State ZIPCode County
• . Primary nrnnvrty owner contact name ail