HomeMy WebLinkAboutHomestead_Bilderback INDIANA SALES DISCLOSURE FORM SDF ID: • Page 2
D:PREPARER •
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LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Form Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES.LLC
Address(Number and Street) Company
EVANSVfLLE,IN 47708 812-468-8485
Coy,State,and ZIP Code Telephone Number E-mail
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E.SELLER(S1/GRANTOR(S) -• - - r ;--rt - ' -
RONAI OM JOHNSON STACFY 1) JOHNSON
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
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Address(Number and Street) Address(Nu •b-(6nd' rt)
E/he r pzi a' "AI 176,- 45
Uncle enalties op • 'ury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a co I to as re r red by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Propert 'Sales Disclosure Act".
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namre of Se er Sig a Seller 7
Konc`(Cd . J()Nitso 1 d ia97/S sr-ace, D . ' ai,rccti-l 1 f5
Printed Name of Seller Sign Date(.vu/DD/MY) Printed Name of Seller _� Jo Dtv/oon-m)
P,•I3UYER(S)%GRANTEE(S]. APPLICATIONE.ORI-If tbP,ERTYITAXDEDUCTIONSI7DENTIFYALli•(�,":".SEHITAADI3kN,_ ->_ z-: -
GEORGETTA BILDERBACK
Buyer;-Name as appears on copveyance document Buyer 2-Name as appears on conveyance,. _�
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Address(X and and Sa ) l Address(Number and Street) 4.61.
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YES NO CONDITION I YES NO CONDITION CD/r •�
1117):947
5 ❑ 1.Will this property be the buyer's primary 0 ID 3.Homestead /n
residence? Provide complete address of primary ❑ 5 4.Solar Energy Heating/Cooling SystL�+li
N 1 residence,including county: ❑ TOR
I
19 N . all(( 1VP, S.Wind Power Device
jdress(Numberand t) ❑ 0 6.Hydroelectric Power Device
`^-�ni o `-I1-4 1 NI `iuo l be-2011 ❑ 5 7.Geothermal Energy Hearing/Cooling Device
cit.State ZIP Code County
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2.Does the buyer have a homestead in Indiana to be ❑ 5 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.
Not available in all counties.)
Address(Number and Street)
CiN,Smte ZIP Code County
- /3-/3- ,- a:20.°43% 002
• Primary pro perry owner contact name E-mail