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Homestead_Cox (2)
INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1814127 Page 2 D. PREPARER Bryceann Cutsinger Preparer of the Sales Disclosure Form Title 226 W Broadway Broadway Title,Inc Address(Number and Street) Company Princeton,IN 47670- 812-386-1687 samantha.bti @mw.twcbc.com City.State,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) Donald Marquez Seller I•Name as appears on conveyance document Seller 2-Name as appears on conveyance document 5395 N Old US Hwy 41 Address(Number and Street) Address(Number and Street) Patoka,IN 47666- Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and come as equire by aw,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signs e of Seller ,r'��-S "61111,,,a..._ Signature of Seller ea V%4 Cl> f '' lIo tz � 9 Pn'"YANLSI MG", RA cinn PROPERTY TAX Pr:IOAN-ID Seller NT y ' nnrvwn F.BUYER�S11GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITE H T PPL Imothy A Cox___D Amanda Lynn Cox Buyer I•Name as appears on conveyance document Buyer?-Name as appears on conveyance document 80 W 15th Street 80 W 15th Street SEP 17 2015 Address(Number and Street) Address(Number and Street) Vincennes,IN 47591- Vincennes,IN 47591- 4 THE SALES DISCLOSURE FORM MAY RE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CUJ'IDIllQN © ❑ 1.Will this property be the buyer's primary © n 3. Homestead-) residence? Provide complete address of primary min—in 4.Solar Energy Heating/Cooling System • residence,including county: ❑ © 5.Wind Power Device 5395 N OLD US HWY 41 Address(Number and Street) ❑ © 6.Hydroelectric Power Device Patoka,IN 47666 GIBSON ❑ in 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 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. • avai as e in all counties. Address(Number and Street) el . —O4-/3-.00 -0OA 5 78-0 se City.State ZIP Code County Pn. name E-,nail