HomeMy WebLinkAboutHomestead_Leary INDIANA SALES DISCLOSURE FORM SDF ID: 2015 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 teresa @swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Shelly Heldt
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
206 S Third
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665 ,
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 y law, nd i�pared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature of Seller\e'r�t)) / Signature of Seller
Shelly Heldt L-2-1.0b
Printed Name of Seller Sign Date(MM/DDNYYY) Printed Name of Seller Sign Date(MM/DDNYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Robert A. Leary
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
300 E Sinclair,Apt. 11
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 ,
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
5 ❑ 1. Will this property be the buyer's primary a ❑ 3. Homestead F D
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Coo ing ys em
residence,including county:
206 South Third Street ❑ a 5. Wind Power Device JAN '9 2015
Address(Number and Street) ❑ 9 6. Hydroelectric Power Device
I ❑ 0 7. Geothermal Energy He. g/Coo; • �i-
,Owensville, IN 47665 Gibson �, , TV_P, a dye
City,State ZIP Code County ❑ El 8. Is this property th. .• vl-r. V-r ' AUDITfl
❑ 0 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for mis
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)
362-1 /7- IA aoa -aoorao�3-oaa
City,State ZIP Code County Primary property owner contact name E-mail