Homestead_Shaw (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
LD.PREPARER .
CHRISTINA LATHAM TITLE CLERK
Preperer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE. IN 47715 812-402-4553 CHRISTINA(dIREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
SELLER(S)%GRANTOR(S) - _ - _ _ . . - -
Michael L Moore
Seller I-Name as appears on conveyance document Seller Z-Name as appears on conveyance document
(389 S. 5o Ens
Address(Number and Street) Address(Number and Street)
PRlivcrron& . £13 14?t 20
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and comple��required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/Thcith Signature of Seller ! "V° " ���� Signature of Seller
Michael L Moore -2Oj'5
Printed Name of Seller Sian Date M.N/DO/YTYI) Printed Name of Seller Sian Date lMM/DD/Y/YTI
F.BUYERS)/GRANTEE(S)7 APPLICATION.FOR PROPERTY_TAX DEDUCTIONS 7,IDENTIFY ALL.ITEMS THAT APPLY ,. _ __ _._Charles A.Shaw Gloribeth P. Shaw
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document,
217 W- 4 4./Cenf Son Av. 3r1 4)- Mclkcncern ir-e-
Address(Number and Street) Address(Number and Street)
`
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA ••LY
YES CO CONDITION
�
I YES NO CONDITION
❑ 1.Will this property be the buyer's primary �❑ 3.Homestead ~
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating dogleg System
residence,including county:
❑ 5 S.Wind Power Devic- 2 015
317 Makemson Ave
Address(Number and Street) ❑ 5 6.Hydroelee it is")
I 47670 Gibson ❑ 0 7.Geothermal Enera.t tP�i; i ;-Device
City,State ZI Code County
❑ 0 8. Is this property a residentia144148roperty?
❑ 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax statemAts 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(N'umberand Street)
(^ (— );%, —;o3— 000 •�4 g 9ig
City.State ZIP Code County �
Primary property owner contact name E-mail