HomeMy WebLinkAboutHomestead_Heldt1 J
L
INDIANA SALES DISCLOSURE FORM SDF ID: P j� Pa e 2
`sDi,PREPARERc. �,. ":'.s . ;>.'t _ .a : .':-� ... _.` { `,._ :z = c -� _`� � _i;, �: �:.,
Christooher E. Carl Setilement Aaent
Preparcrajlhe Sales Disd�ure Form Tirle '-
101 Plaza East Blvd., Suite 702 True Title Service. LLC
Addres(A'umbrrand5lreet) Compan��
Evansville. Indiana 47715 (
E�mall
;E�SELhER S ' GRANTOR S .. R ., � .. � _ � � " , �-• �'.— _
_-.. F : � r . 2 .,..
.. s .� �� .i '-. _`a i�. �. "� '� , .... . 1
.Y. 'i_�� Rs'..f_�_,
Roger D. Courtney Sharon I Courtney
Seller7 - iVame asappears on com•evmre darument Selle� 2- Name as appears on ronvevance document
SOO S %7S WP.B� �QQS %7�J �/1�QSt
Address (A'uaarr and 5[rcet) Address (A'umber and Strec[)
Owensville. Indiana 47665 Owensvi�le. Indiana 47665
� �-ma(�
Under penalties of perjury, I hereby certify that [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and compl as req ed b w and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
� �.. ,� �� .� S-t,_.�..-- L_ �4--�
Signamre o(Scila �q Sipnature of5eller �j ��p
Roaer D. Courtney I 1`�/ / 20�2 ��ron L Courtney d/ It7! 2012
PnntedXameof5eller SianDatelAll/OD/Y1Y1'1 PAntedNameo;5eller SianDateWM/DD/YYi'19
S . E S':AP,P.LIGATIONlFORlPROPERT,Y.TAXDEDUCTIONS=IDENTIF}'rALI.iITEMS:TH'ATAP.PLY-c =, £ z..:?'�
Carrie M. Mullen
Buverl-Nameasappearz anvewnredorumen: Bwer?-Nameasappearsoncomevonredocvmrn�
ad
Address (h'umber and 5[reetJ Addr¢s (A`umber ond Svee[)
Hazleton. Indiana 47640
Cig.Smre, and Z1P (ode lipc Starc. and ZIPGorie
E�mail TeleohoneNvmber E-mall
THE SALFS DISCLOSURE iORM DIAY BE USED TO APPLY FOR CERT.V � DEDUCf10�S FOR THIS PROPERT'. IDE�TIfl' ALL OF THOSE THAT APPLY.
YES NO CONDRION YFS NO CONDI'f10N
Q � 1. Will this property be the buyer's primary I Q � 3. Homestea
residence? Provide complete address of p' rv 4. Solar Energy Heating/Cooling System
residence, induding county:
500 S 775 West ❑ ❑✓ 5. Wind Power Device
Address(Numberand5trettJ ❑ Q 6. Hydroelectric Power Device
Owensville. indiana 47665 Gibson � Q 7. Geo[hermal Ener�� Hea[ing/Cooling Device
Liry�. � ❑ZIPCode Counn�
2. Does the buyer have a homesiead in Indiana to be � ❑`� $• is [his properq� a residentlaf rental prop=_r[y?
vacated for this residence? If yes, provide ❑ ❑� 9. Would you like [o receive [ax s[atements for this
comple[e address of residence bein� vacated, property via e-mail? (Provrde contact injorniation
including county: below. Please see instructions for more information.
2935 E. John Ford Road Not availoble in all counties.)
Address (Xumber and Sneet) d I�- � 1- a a- z.en ero I 3 0 2 0�.1
Hazleton. Indiana 47640 Gibson Carrie M. Mullen
Cip�, Sm[c ZIP Ladc County
- Primoryproperry'ownerrontactnume E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belie(, is true, correct
and complete as required b}' law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Ac[". (Note:
Spo information, Social Security and Driver's License/Other numbers are not necessar}� if no Homes[ead Deduc[ion is
'n file ) \� �,\\,��
� D �` `
Sigmvire o(Buverl p 5(gnawre o(Buvrd/5?ouse
�arrie M Mull=n � I 1/?D12
Pn'ntedLegalKameofBu}rr] SicnDa:t(HF(/DD/YYYI'j PrtnfedlegalA'ameajBuver?/Spouse Sign�ate(uAl/pD/tlri)
Lost i digi6 o�Buycr I Dnecr's Smm Las[ 5 Digrts oj SxialSecuri[V Num6er Las. i digiCt of Buyer Z/Spouse Dnver'S Smte Las[ i Digits oj Sodal Setuntv
License/ID/OrherNumber Number License/ID/OrherNum6cr