Homestead_Michael III INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
,Dr:PREPARER'jj _ l ry`�.. �ry_.._.__ _-177-71.77-r. .a<---- , '" y' F
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(aREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number
E-mail
E..SEIER(S%GRATOR(S) _iFr, ,,:�. ..s v-.-,,rgir ! r> _f"S S._ t_ __r v r ^,. F X r_ t T..i y-...
Tony Alan Washburn Millette l Washburn
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
X ;;.:97_ / > 2 7.%2,-/ d g a l S (cis s i/J
Address-(Number and Street) __ Address(Number and Street)
X�yfr,.> C/"_%-/-47 - / =171 1-y Q enSU1111 tkl 1-0(DIPc-
Under penalties of pu ry„P reby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete qu ed law,and• t ep. ed in accordance with IC 6-1.1-5.5,"Real Pro erty Sales Disclosure Act".
Signature of5/ e 1 J Signature of Seller
Tony Alan asbbum 1( / �/J Millette L Washburn I - - 15
Printed Name o/Seller Sian Date(M.M/DD/YYYY) Printed Name of Seller Sian Date(M.M/DD/YYYY)
I U,YER(SILGaNTEE(sI APPLICATI0\FOR,PRO$ERTY.TAX•DEDUGTI0NS�.1 1DENT1EY.ALI:IITEMS,THAT?APP,LY C -rri
James E.Michael,III Kelly L.Michael
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
-7)d, S . T-t/s-i S ee!y 71-2 5. F;r5/ reel
Address(Number and Street) Address(Number and Street)
aar�� /91' n )Al y7(070 Pr,nrd im /11 y,J67D
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT;PPL . 1_ s
YES. NO CONDITION I YES NO CONDITION
❑ 1.Will this property be the buyer's primary 3.Homestead JAN 13 2015
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Coo 'ng Syst m
residence,including county: ❑
712 S First St S.Wind Power Device
Address(Number and Saeet)
0 12 6.Hydroelectric PotdLCOUNTY AUDITOR
Princeton, IN 47670 Gibson El 1151 7.Geothermal Energy Heating/
Cooling Staaottee ZZZZ,IP Code County �' o Cooling Device INI❑ Is/'I 2.Does the buyer have a homestead in Indiana to be I❑I 8•Is this property a residential rental property?
/�" vacated for this residence? If yes,provide I I 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.
Not available in all counties.)
Address(Number and Street)
210-ta - 071303.003. R'S 41. Oa EC
City,State ZIP Code County
Primary property owner contact name E-mail