Homestead_Hurt (8) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER . -
Laura Rininger Closing Coordinator
Prepare of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services, LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 _
City,State,and ZIP Code Telephone Number E-mail .
E.SELLER(S)/GRANTOR(S) - - - - ' - - _
Mary I Dittmore
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
707 Kennedy Dr
Address(Number and Street) Address(Number and Street)
Ft 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".
Signature of Seller Signature of Seller
Mary L Dittmore by Patricia loan Rodgers AIF 11/3/2014
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYY1)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX-DEDUCTIONS—IDENTIFY ALL ITEMS T -
6: Jacob M. Hurt
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
7912 S.45 E. NOV 1 Address(Number and Street) Address(Number and Street) 1 O 2014
Ft.Branch, IN 47648
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION DIT111y
0 ❑ 1.Will this property be the buyer's primary o ❑ 3.Homestead
residence? Provide complete address of primary ❑ U 4.Solar Energy eating/Cooling System
residence,including county: ❑ 0 5.Wind Power Device .
707 Kennedy Dr.
Address(Number and Street) ❑ 12 6.Hydroelectric Power Device
Ft. Branch,IN 47648 Gibson ❑ TA 7.Geothermal Energy Heating/Cooling Device
City,State ZlPCode County
❑ TA 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 ❑ IN 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)
A6 -/1?-/-5-/W - 00/. X19-07.6
Ciry.State ZIP Code County .
Primary property owner contact name E-mail