HomeMy WebLinkAboutHomestead_Simms (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D. PREPARER _,_, -
Pam Hancock title administrator/closer
Preparer of the Sales Disclosure Form Tide
221 NW Fifth St Loch/ear Title, LLC
Address(Number and Street) Company
Evansville, IN 47708 812-421-8405 oamela(a'lockveartitle.com
City,State,and ZIP Code Telephone Number E-mail
II.E.SELLER(S)/GRANTOR(S)
.s- .. '-.. . e... .l.
Seller l-Name as appears on cony once document Seller 2-Name as appears on conveyance document
ZAP11 U) (HODO
Add�r�(Numberand Street) Address(Number and Street)
N-1/1.h5-{2V1 , .� 2l i(A31
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and //
mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
.�Y�//.•f/lt_ L_ r R . Rcj / :Ti -, .1i uUD
Signature of Seller oI Signori re f Iler 1 _ p
flllane I F pert 9&'o3I2DI.SJ Pegay J E if 9u/0 /)015
Printed Name of Seller Sign Date(MM/DD/YYYI') Printed Name of Seller Sion Date(MM/DD/YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION'FOR PROPERTY TAX-DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY ,. .- , _.
Jarrod Lance Simms and Jennifer Christine Simms, husband and wife - !!
Buyer I-Name as appears on conveyance current Buyer 2 Name as appears on conveyanced u�rnt�/
so F. 6s�-) Q-� •
Address(Number and Street) Address(Number and Street) AUG 2 1 2015
X01.512 f, NO �h�3�' G 1 L
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
( ❑ 1.Will this property be the buyer's primary z ❑ 3.Homestead
residence? Provide complete address of primary — as •. oar nergy Heating/Cooling System
residence,including county: ❑
500 E Gibson Street S.Wind Power Device
Address(Number and Street) ❑ E 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
gt ❑ 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 ❑ E 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.
4444 )014v-Fit J.IIer D . Not available in all counties.)
_address(Number d Str
L,�vcln5t/I IVv. i 471/1 1441,,r!i/,rbki1!i-k__, & - 19-3 ►.-3 oU-tO o.O1( -0°5'
CityState ZIP Code I County
Primary property owner contort name E-mail