HomeMy WebLinkAboutHomestead_Klem INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
.D.PRERARER
Sherri S Hudson Closing Manager
Preparer of the Soles Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville. IN 47708 812-421-4000 sherrihudsonejeffbosse.com
City.State,and ZIP Code Telephone Number E-mail
'_E.,SELLER(S)%GRANTOR(S),_ - - - . .
Dustin C Haynes
Seller l-Name as appears on con rey nce document Seller 2-Name as appears on conveyance document
2.07 3 4 e Si'
Ay'dress(Number and Street) /� _ Address(Number and Street)
(/,4' a'rena t.i , J 6a V3?
Under pe ies of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn! • a e q uire by I w nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
frb 91
Signature of Seller Signature of Seller
Dustin C Haynes 7-17—/.5"
Printed Name of Seller Sian Date(M,I/DD/YYYY) Printed Name of Seller Sipn Date(M.M/DD/YYYY)
:E.BUYER(Si/,GRANTEE(S) AP.PLICATION.FORPROPERV_TAXTDEDUGTIONS-1IDENTIFY ALL ITEMS,THA'E APPLY_,
Dustin L. Klem
• er1 Name appears on conveys ce document Buyer 2-Name as appears on conveyance document
oa Al /o 00
Address 4Num/berand Street) Address(Number and Street)
Coe igirle Tilei L/7sa)(
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TNAT APPL\. H f
YES NO CONDITION I YES NO CONDITION t
It/ ❑ 1.Will this property be the buyer's primary n 3.Homestead i L 3 i LOIN
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heaaaaa�����ng(Co Lin ystem
residence, including county: ❑ 0 S.Wind Power D
Address(Number and Street) El 0 6. Hydroellee�cttri Yower iceAUDITOR
City,State ZIP Code County Fl 7.Geothermal Energy Heating/Cooling Device
t�❑ 2.Does the buyer have a homestead in Indiana to be ❑ I� B. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 1g 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including c nty: below.Please see instructions for more information.
raDomit /Obo '7 /�/L( Not available in all counties.)
Addrer/(.5ut.,'rta'tnd Street !//s� / VW LQ oS a - 10 3(0- goo - coo. 9 -c9
Ciry,State ZIP Code `' County
Primary property owner contact name E-mail