Homestead_Mabrey INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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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(@REGIONAL-LT.COM
City.State.and ZIP Code Telephone Number E-mail
tEo SELtiER(S)/GRANTOR(S)-_ - � .-.•_ - - - ._._ �:__ -_.- --.. _ ' :.:. -.-'==
Joshua D Bruce
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1(992 s 5h S7
Address(Number and Street) I 1/ r Address(Number and Street)
•
- OCgc(A CIi-
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and compl• e as required by w,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/ to /4 Si,.• re of Seller / ..,�( Signature of Seller
'la (1 Bruce (7c---- " I
Printed Name of Seller Sion Date(M.N/DD/YYYY) I Printed Name of Seller Sian Date(N.H/DDATM
,r BUYER(S)/GRANTEE(S)r.APPLICATION FOR.PROPERTYITAX,DEDUCTIONS_IDENTIEY.ALL ITEMS THAT APPLY. -•J.:..±.--
,"• :_-__:_•
Masami Mabrey ,llis.
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on convey" • me' .t
50 9, )S. L;1 / Wit. ' '
Address(Number and Street) /� Address(Number and Street)
(`)a k 14 0 c C f H' /n/ y 7 ‘‘O MAY 2(4 2015
,I �%' mm AUDtTO
THE SALES ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P . •• - . -.- - GIB ��•bbUS
YES NO CONDITION YES NO CONDITION
n 1.Will this property be the buyer's primary I �n 3. Homestead
residence? Provide complete address of primary • ,/ 4.Solar Energy Heating/Cooling System
residence,including county: ❑ 151 5.Wind Power Device
1697 S SR 57
Address(Number and Street) ❑ 5 6.Hydroelectric Power Device
Oakland City, IN 47660 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City;State Zl Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes, provide ❑ 5 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) rd(_13_�1 !00 -ow-i O-0O!
City;State ZIP Code County
a VT CJ E-mail
Primary property owner contact name