HomeMy WebLinkAboutHomestead_Randell Sr 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
Ciry,State and ZIP Code Telephone Number E-mail
_ E.SELLERS)/GRANTOR(S) - . - -
Marilyn K Ireland(Known as Marilyn K Sellards)
Seller l-Name as appears on nv vncedocum t S�A_ Seller 2-Name as appears on conveyance document
n/ 3 ) AK C'Iiuy ch
,Addrenc(NumberandStreet)s� r-� Address(NumberandStreet)
ifOs°2 J/ ✓ € 1 LLF / /Y
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and cetg as quired bylaw, rid i�in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
5{gnaNre of Seller S{gnature of5eller
Marilyn K Ireland(known as Marilyn K SellardslY ,
PrintedNameofSeller Sign Date(MM/DD/YYY1) Printed Name of Seller te(M.4/Da/YYYi)
F.BUYER S GRANTEE S -APPL ICATION FOR PROPERTY TAX DEDUCTIONS'IDENTIFY AL !1 EM TIMMS '. _
t Jon E.Randell &1)
Buyer 1-Name as cooears on conveyance detrment Buyer 2-Name as appears on conveyanc t4cujne9 2015
(lzt. �) � 1L. SLR J
p ess(Nvmoerun�.,......., Y C,- ) Address(Number and Street)
1. 9--0, Trl`ell 11'' ..tiIc /.I.r
THE SALES DISCLOSURE FOILM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I F< COStIT ON
;4- 3' 1.Will this property be the buyer's primary ( !, 4 f 3.Homestead
residence? Provide complete address of primary II 0 4.So ar Energy Heating/Cooling System
residence,including county: 0 12 5.Wind Power Device
6680 S 1095E
Addr ess(A'umberand Street)
❑ is 6.Hydroelectric Power Device
Addr
Oakland City, IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
111 ❑ ❑ is 8. Is this property a residential rental property?
2.Does the buyer have a homestead in Indiana to be ❑ 9 Would you like to receive tax statements for this
vacated for this residence? If yes,provide
complete address of residence being vacated, property via a-mail?(Provide contact information
including county: below. Please see instructions for more information.
Not available in all counties.)
Addre s(Number and Street)
e?" . $20 - fy _ a.c o-o o/. $4 -O O Y /
Ci State ZlPCode County E-mail
ry• Primary property owner contact name