HomeMy WebLinkAboutHomestead_Delong (5) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 '
D:PREPARER-- - -- ----- — - — --- - — ---- - --- --'-- - --- --- ----- --
Angie Pace Title Assistant
Preparer of the Sala Disclosure Form Title
1911 Lincoln Avenue Clear Title Company
Address(Number and Street) Company
Evansville,IN 47714 812-423-8854
City,State,and ZIP Code Telephone Number E-mail
E:SELLER(S)/GRANTOR(S):_ _ _-- _.-� .__r_ . _�---_
I aflonna Rooster Co-Personal Representative James M KIPSPI Co-Pereonal Representative
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
505 E. Park St. 142 F &50 S
Address(Number and Street) Address(Number and Street)
Ft. Branch. IN 47648 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 c• 1 p ete as required t y law,an* is p epared in accordance with 1 1.1-5.5,"Real Pro erty Sales Disclosure Act".
i �/ �/
Al 4(1444) ,(I/f1� a . A -ice A'm&s-- ?�- / „to 0,2_9,
Si' atu eo ler • Sign %°f Seller
_I-Lo As N1 n -Hop 1er-+- l02 /b /$ at)/>,es m l</esel -a /e2.-/C-79
Printed Name of Seller Sian Date(MM/DD/1717) Printed Name of Seller Stan Date(M.M/DD/YYYY)
,FBUYERS)/GRANTEE(S)=APPPlCATIONFOR,PROPERTYTAXDEDUCTIONSiIDENTIFY'ALL ITEMSTHATAPPLY __'__= 'r ___
Russel DeLong
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on cony n u t ED
13 W. Red Bank Rd
Address(Number and Street) Address(Number and Street) �t
Ft. Branch, IN 47648 - aOjyR°
TIIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR T. . -'OPERTI'. IDENTIFY ALL O a !" rlb
YES No CONDITION I YES NO CONDITIONGIBSON COUN •UDITOR
5 ❑ 1.Will this property be the buyer's primary 5 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ SI
13 W Red Bank Rd S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
_ Ft.,BranchjN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 ❑ 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 ❑ d9.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.
836/w, 1333;s 93'7 W 1606 5 Not available in all counties.)
Address(Number and Street) / `/ '1 .,.,C^ _
c
Haubstadt, IN 47639 Gibson -13— T—ao / - coo. &w-O�,
City,State ZIP Code County
Primary property owner contact name E-mad