Homestead_Jackson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Karen S.Creek Closing Agent
. Preparer of the Sales Disclosure Form Tide
501 Main Street, Suite 101 Bosse Title Company
Address(Number and Street) Company
_Evansville, IN47708 _ - 812-421-4000 karen.creek@jeffbosse.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) • •
Dixie K I emmons
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
11570 S 150 W
Address(Number and Street) Address(Number and Street)
Haubstadt IN 47639
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".
rl ' K. ,ran Me s -
Signature oSeller Signature of Seller
Dixie K I pmmnns 4.4{,Q 3
Printed Name of5eller Sian Date tMM/DD/YYYYJ Printed Name of Seller Sian Date(MSI/DD/YYYY1
F: BUYERS)/GRANTEE(S)_;APPLICATIONEOR PROPERTY-TAX DEDUCTIONS=IDENTIFYWALL ITEM�THAT AFPLY j
Brenda L.Jackson l
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyanc-docu; nt,'
1009 S.Center Street
Address(Number and Sweet) Address(Number and Street)
Fort Branch, IN 47648 J�'1': l
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE i F1NT?*
YES NO CONDITION YES NO CONDITION 40,/'
1 ❑ 1.Will this property be the buyer's primary 12 ❑ 3. Homestead OR
residence? Provide complete address of primary ❑ 51 4.Solar Energy Heating/Cooling System
residence,including county: ❑
ri 5.Wind Power Device
Address(Number and Street) ❑ Q 6. Hydroelectric Power Device
❑ NI 7.Geothermal Energy Heating/Cooling Device
❑City.State r Code County
2. Does the buyer have a homestead in Indiana to be ❑ 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)
Z (o—i r - 2y - Z04' Coo 49 ? aa6
City.State ZIP Code County
Primary property owner contact name E-mail