HomeMy WebLinkAboutHomestead_Bridges (2)aat.cn u13ULVJUK PUKM
SHANNON LIBBERT MANAGER
PmporeraftheSales Disclosure Form Tide
Address (Number and Street)
REGIONAL LAND TITLE
Company
EVANSVILLE IN 47715
-mail
CHRISTOPHER J GOODMAN
Seller 1 - Name as oppeorson eame}uncedocumeat
.= 5 5> , A) 1� �
Address (Number and Street)
('') wensu;lle , �) y76ro 5
City Smtm and ZIPGde� `
Seller 2 -Name as appears on onve)anre document
Address (Number and Street)
Gry; Stem and ZIP Code
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
apd complete al; required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
9556 W SR 165
Address (Number and Street)
Signature of Seller
�z6 /O
FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR
YES NO CONDITION
Q ❑ 1. Will this property be the buyer's primary I
residence? Provide complete address of primary
residence, including county:
9556 W SR 165
Address (Number andStreet)
OWENSVILLE IN 47665 POSEY
Cary. State ZIP Code County
Q Q 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (Number and Street)
City.Smte ZIPCode County
Buyer 2 -Name as appears on wnveyanee document
Address (Numberond5tree[)
City, Smm, ..d ZIP Code
THOSE THAT APPLY.
❑
❑✓
4. Solar Energy Heating /Cooling System
❑
✓❑
5. Wind Power Device
❑
❑./
6. Hydroelectric Power Device
❑
❑✓
7. Geothermal Energy Heating /Cooling Device
❑
❑✓
8. Is this property a residential rental property?
❑ Q 9. Would you like to receive tax statements for this
property via e-mail? (Provide contact information
below. Please see instructions for more information.
Not available in all counties.)
o?G -/�9- o C/- oo- oal 9i/ - oo-1-1
JACKIE LEE BRIDGES NA
mnma name
E -mail
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 by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". (Note:
Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
Lost 5 digits BfBuyer 1 Driver's Stow Lost 5
Llcense/iD /Other Number
Signature ofBuyer2/3)3ouse
Pnnted Legal Name of Buyer 21Spouse Sign Dow(MMIDDIiTV1)
Lost S digits ofBuyer2/Spouse Driver's State Last 5 DigitsofSoclal5ecurlty
Number License /ID /Other Number