Homestead_Shake • INDIANA SALES DISCLOSURE FORM SOF ID: 2013 _ Page 2
D. PREPARER
Teresa Holifield Escrow Officer
Preparer of the Sates Disclosure Fern Tide
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,Stale,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Kyle D.Thomas
Seller 1-Name as appears an conveyance document Seller 2-Name as appears on conveyance document
521 West Cleveland Ave.
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
•
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".
nature of Seller Signature of Seller
Kyle D.Thomas 12120/2013 /2120/2013
Printed Name of Setter Sign Date(MMADNYYY) Printed Name of Sewer Sign Date(MM,DD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Lori J.Shake
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
2110 Ashton Court Apartment 3
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 •
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
0 ❑ 1. Will this property be the buyer's primary P ❑ 3. Homestead
residence? Provide complete address of primary ❑ E 4. Solar Energy Heating/Cooling System
residence,including county:
❑ 6 5. Wind Power Device
521 Cleveland Avenue
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
;Princeton, IN 47670 Gibson
❑ El 7. Geothermal Energy Heating/Coaling Device
City,Ste ZIP Code County ❑ 7 8. Is this property a residential rental property?
❑ J� 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
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)
kia-I8- 30t- boa .a∎o - bay
City,State ZIP Code County P mar/properly owner contact name E-mail