HomeMy WebLinkAboutHomestead_Hall INDIANA SALES DISCLOSURE FORM SDF ID: 2014 Page 2
D. PREPARER
Teresa S. Holifield Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 tresa@swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Jesse A. Simmons Andrea B. Simmons
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10206 S Quail Crossing Or 10206 S Quail Crossing Dr
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 Haubstadt, IN 47639
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
and_scanplete-as-requi ed-by-law,and is prepared pared in accordance with 1��1.1 �Property Sal Disclbsure Ac
r
S gnature o rcler Signature of Seller
Jesse A. Simmons 12/18/2014 Andrea B. Simmons 12/18/2014
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)IGRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Steven B. Hall Jennifer D. Hall
Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
S18ENl( 818 E Mill FILED
Address s(Number and Street) Address(Number and Street)
Evansville, IN 47711 ((�� Evansville, IN 47711
a ID 1. Will this property be the buyers primary 9 ❑ 3. Homestead GIBBON COUNTY AUDITOR
residence? Provide complete address of primary ❑ El 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 9 5. Wind Power Device
10206 South Quail Crossing
Address(Number and Street) ❑ 9 6. Hydroelectric Power Device
Haubstadt, IN 47639 1 Gibson ❑ 9 7. Geothermal Energy Heating/Cooling Device
City, State.ZIP Code County ❑ 9 8. Is this property a residential rental property?
❑ k 2. Does the buyer have a homestead in Indiana to be ❑ 9 9. Would you like to receive tax statements for this
vacated for this residence? If yes,provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) 9&i _I g-'3-3°ll_ 00a . o 1`�I_ ,n 29
City, State ZIP Code County Primary property owner contact name Q[ �( E-mail