Homestead_Miller (12) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT.COM
Eby,State,and ZIP Code Telephone Number E-mail
.ESELLER(S)/GRANTOR(S)_ �- _ . -- - .- - -
Patricia Miller(aka Patricia A Kramer)
Seller I-Name as app pars on conveyance document Seller 2-Name as appears on conveyance document
X (p A) Me,°,A .s'--
Addr��Numb,and Street) Address(Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and con Ire as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
/
Patricia Miller
-%>2 /U S
Printed Name o(Seller Sian Da (M./own') Printed Name of Seller -Date(MM/oo/iYYY)
F.:BUYER(S)/GRANTEE(S)_APPLfCATlON FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY/[,r.. _ _..
Kenneth J. Miller
Bye• -Name as appears on ronveyonrepgcame i�j Buyer 2 Name as appears on conveyance document
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,X West Per.i /.Sat, t K0a-„-1 oci
Address(Number and Street) Address(Number and Street)
X S IZ - ?o6 -5cm9 - sli
Y SALES DISCLOSURE
ORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TIS PERK IDENTIFY ALL OF THOSE THAT APPLY. qU.4)..YES
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑
9 W Red Bank Rd 5.Wind Power Device
Address(Number and Street) ❑ Fl 6. Hydroelectric Power Device
Fort Branch. IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Fl 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.
Not available in all counties.)
Address(Number and Street)
al‘-if- d - AAoo3- ate. 9/9- oaf
City.State ZIP Code County
Primary property owner contact name E-mail