Homestead_Bell INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER____. _ T
LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Forni Tide
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES, LLC
Address(Number and Street) Company
EVANSVILLE, IN 47708 812-468-8485
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S).,:., _ H' . -_ - . ^ . .. - r. .
I ARRY I RI IRCHFI l SUSAN C BURCHFLL
Seller l-Name as appmt;on ca veya eedocument Seller 2.Naine osa pecan anconv nee uc t
4)9\ S. /St St �o �• /S> � iz
Address(Number and S / Address(Number ands t)
°WPM VVI/L/A/l `f 7C %i5 floa)MULNo /,U c7W5
Under penalties of perjury,1 hereby certify that this Sales Disclosur to the best of my knowledge and belief,is true,correct
and co as re Ire by law,and is prepared in accordance with 1 1.1-S.S,"Real P rty Salosure Act".
re�-eet. 1/.
9g atur fSe rcr sure of Seller in
(I.rrl,- L . I��i.l�rC'i�F'.11 5-5-)5 �'uS(uq L - rctle/! 5-5 -l5
Printed Namq' 1Seller Sian Date(MM/oon'yY1 Printed Nome of Seller Sign Date(M.MIDD/YYni
F.BUYER(S)/GRANTEE(S)=APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY -.
BRAD BELL LESLIE BELL
Buyer l-Nameas°purars on convey redocumenl Buyer 2c-Nome as app�e ion nconveyance document
ddress(Number and `ea (S, ka "x i��
i u n 2 i hi y 7Lo7O l %lu(Number Street)
/7 ) (77070
•
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL Or THOS I-I AT ! P '
YES NO CONDITION /�
12 ❑ 1.Will this property be the buyer's primary l 1+ l n 3.Homestead MAY 1.2 2015
residence? Provide complete address of primary
re ide ce yncluding county: ❑ 4.Solar Energy Heating/Cooling System
S' jS c t) L� ❑ 0 5.Wind Power Devic
Address(Number and Street) -1 / /.--1,
'����e- /� ❑ 6. Hydroelect ' P
OwenAI)(Vyft /N V-/OAS C-(hSo77 an OUNTY�AUDITOR
evic
❑ SI 7.Geothermal Energy Heating/Cooling Device
City,State" PCode to
by
❑ g Is this property a residential rental property?
1 2.Does the buyer have a homestead in Indiana to e
vacated for this residence? If yes,provide ❑ Is 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)
1c- 1-7-/ a_ ao v- coo. OG(0-ado
Gry.State ZIP Code County
Pnma,y property owner contact name E-mail