Homestead_Simpson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
CHRISTINA LENFERS CLOSING AGENT
Preparer of the Sales Disclosure Form Title
501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 (812)421-4000
City,State.and ZIP Code Telephone Number E-mail
.E:-SELLER(S)/GRANTOR(S) .
THOMAS BLACK
Seller 1-Name as appears an conveyance document Seller 2-Name as appears on conveyance document
S'55-.7 -riu l 1crSViUJ Lid/
roc (Number ands ) Address(Number and Street)
i uu en / 3'7
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
any co s required.b , nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
1gr
nature of Seller Signature of Seller
THOMAS BLACK 11/06/9014
Printed Name of Seller Sian Date IMM/DO/YYYY1 Printed Name of Seller Sign Date tUM/DD/YYYPI
F2BUYER(S)/GRANTEE(S)-APPLICATIONvFOR,PROPERTY TAX.DEDUCTIONS-IDENTIFY-ALL ITEMS THAT APPLY _
STEE DANIELLE SIMPSON
Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
20441 OLD PRINCETON RD
Address(Number and Street) Address(Number and Street)
YES NO CONDITION I YES ,NO CONDITION 0 COL,
�❑ 1.Will this property be the buyer's primary ❑�-.� /3.Homestead G'D .A.t
residence? Provide complete address of primary El L(X •Solar Energy Heating/Coolin. '.te •
yJ-.1.2 resid ncLee,including county: ❑ _Wind Power Device 4,)
A�(Number and Street) f;�� t ❑ 6.Hydroelectric Power Device 04
Irk-.'l CP-Art Bit T 7&901 �(GScn ❑ 8'7.Geothermal Energy Heating/Cooling Device
City.State ZIP C e County I--y
❑ "Does the buyer have a homestead in Indiana to be ❑ Lt�d/ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ LJ 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 availabl all counties.)
Address(Number and Street)
City,State ZIP Code County
c71 /a-09 d3-�3./ 3-a72
Primary property owner contact name E-mail