Homestead_Bristow (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER . _ _ - _ -
Sherri S Hudson Closing Manager
Preparer of the Sales Disclosure Form Title
501 Main Street, Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville, IN 47708 812-421-4000 sherri.hudson(dieffbosse.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S)
James M Martin
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
iii lEd/• tD e
Address(Number and treet) Address(Number and Street)
/ae/6 s a . 71 , //✓ x/76 ?r,
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".
�j nature of Seller Signature of Seller
lamev M Martin /7/8VA if
Printed Name of Seller Sian Date(MM/DD/YYYn Printed Name of Seller Sian Date(MM/DD/YM
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY - - . _
Zack Bristow
Buyer 1-Name as appears on cony ante document Buyer 2-Name as appears on conveyance document
Address/Num(becar9 Street) �vt ���� Address(Number and Sweet) �s
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I la NO CONDITION alliciiidir-
�� ID 1.Will this property be the buyer's primary ILA, ❑ 3.HomesteadGIBSON COUNTY AUDITOR
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
if '/ residence,including county: ❑
if Di £ ,Jg ST S T. S.Wind Power Device
14.44drnr(Numberandsweet)_.--_ /q� —❑=®=6.,Hydroelectric-Power,Device
tt,8 s tA-D 7 1.N '-L763 9 Cn /,6 S 041 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
OA ❑ 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 ❑ 0 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.
€I 1 S i
" (d ov Not available in all counties)
AQtCRS(Nylnber}rid str ett) 141619 L e
S I ^� 6; o� 210- 23 _010- 1 D 1 6 0 0 a 5 3- 0 09
City,State ZIPCode County
Primary property owner contact name E-mail