Homestead_Alstatt f) •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Stacey S?kman ' Closer
Preparer of the.ales Disclosure Form Title
4962 Lincoln Ave. First Advantage Title
Address(Number and Street) Company
Evansville, IN 47715 812-490-8485 theteam(@firstadvantagetitle.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLERIS)/GRANTOR(S) - —. .k,_ . i t - _
Thomas E Black
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
8587 Taylorville Rd
Address(Number and Street) Address(Number and Street)
Tennyson IN 47637
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and cam 1 e as required by is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Thomas E Black 10/27/2014
Printed Name ofSeller Sign Date(MM/DD/YYTY) Printed Name of Seller Sin ate M D
F.BUYER S GRANTEE(S).-.APPLICATION:FOR PROPERTY.TAXI-DEDUCTIONS=-IDENTIFY ALL ITEMS T P. . -_
ndrew Jordan Alstatt �•f
aem upy."......._ ncedocument Buyer 2-Name as appears on conveyance document NOV 1 - 2014
8461E 900 S
Address(Number and Street) Address(Number and Street)
_Buckskin,IN 47647
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION _ •, ., ,
Q ❑ 1.Will this property be the buyer's primary / ❑ 3.Homestead
residence? Provide complete address of prima • Fl 4. o a eating/Cooling System
Sire 1:nce,includin county:
❑ ni S.Wind Power Device
s( a a eet) I •�,((,,� ❑ RI 6.Hydroelectric Power Device
• 1 `� ILkf Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code 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 ❑ IZ 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: be . •• °• • - - •• . more information.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code C�unry d6 -d?- as jo .t-000. .972 -D30
nary property owner contact name '-mail