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HomeMy WebLinkAboutHomestead_Dewig (5) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 I;D.PREPARER _ t'- 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 812-4024553 CHRISTINA(WREGIONAL-LT.COM City,State,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) lo=hva F Johnson Brooke N Burger Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document U 3 "5, 1J \zS f )cu- 4t' Address(Number and Street) Address(Number and Street) 15 I-7 ft.rc..—c .L/✓ y24 Lld' an-) i Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and con le e as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signar a of Seller - • Signature of Seller j Joshua E.Johnson t b 2L-6 /J Brooke N Burger / 0-Z(O-j 5 Printed Name of Seller Sian Date(M.M/DO/YYM Printed Name of Seller Sian Date IM.M/DD/YYYYI F.BUYER(S)/GRANTEE(S)7-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY-ALL ITEMS THAT APPLY-_-__ _ __7 - - Jan M. Dewiq Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document X 3o s w S•t e- ? _Address(Num er and Street) Address(Number and Street) YES 0 CONDITION I YES r CONDITION G _° - Ale,..? •oz Tai ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead N Coti�A,0 ► ," residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/CooltT� residence,including county: ❑ TO S.Wind Power Device R 503 E Vine St Address(Number and Street) ❑ ❑ 6. Hydroelectric Power Device Fort Branch, IN 47648 Gibson ❑ © 7.Geothermal Energy Heating/Cooling Device City,State ZIP 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 ❑ 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) %, /Q/5 303- 06 o.S/r act City.State ZIP Code County Primary property owner contact name •1 E-mail