Homestead_Turpin (12) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Form Title
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
JASON D SOUTHWOOD
Seller l-Name as appeals on rgy^reyance document�j'�'� (:\ Seller 2-Name as appears on conveyance document
SOg d. ( n�Y1( Q/lill. VA
Ad (Number and Street) Address(Number and Street)
n.(r)til hit- I N (474.70
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete assrre_qu reel-by lAw repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
rea/Seller — Signature of Seller
,
—►1 . 5a hWOOd, (U -8-15
'need Name of Seller Sian Date(MM/DDMMY) Printed Name of Seller Sign Date(MM/DD/nfl
-F.BUYER(S)/GRANTEE(S)_APPLICATION'FORPROPERTY_TAXDEDU-TIONS •IDENTtFYAL LJTEMS:THATAPPLY_->____a -.
NANCY M.TURPIN
Buyer 1-Nfa'mea a peaarssonn tor v 'once document Buyer 2-Name as appears on conveyance documnp•
Addre�i()M ra d/1TU �11 U) or 'LEFF
ss(Number and$[-eet) Address(Number and Street)
-vp iln V LQ)1 I N 117711
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT AP W/
YES NO❑ CONDITION
Willlthis property be the buyer's primary I ❑ 3.Homestead GIBSOrXN^AiOyn/OUN.,-,
residence? Provide complete address of primary ❑ IS 4.Solar Energy Heating/Cooling System TOR
residence,incl i�1co� unty: n
?OS _5, (ii;(c(7r/ Oil 5.Wind Power Device
dl ra(s(1umbercyieet/A.) fj747,\ ,, DthS6it ❑ IN 6.Geothermal Energy Device
State ZIP Code / 7 (J y�J Counry ❑ 7 Geothermal Energy Heating/Cooling Device
ail ❑ 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 ❑ Fl 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
inclui.di county: below.Please see instructions for more information.
�b`t �I5 I CU) Dr Not available in all counties.)
dress(Number Street
ucmns1 11Ie I N t77N Vad a6-//-//gco- oo.J. G9.z-a.Z7
City.State ZIP Code County
Primary property owner contort name E-mail