HomeMy WebLinkAboutHomestead_Clark (6) INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Rocksan Underhill Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 rocksan @swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Glenn 0. Dickenson
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
8308 W 475 S
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665
Under pe alties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
and co 'Ilete as requir-• by la , and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
ignature of Seller Signature of Seller
Glenn O. Dickenson 1/22/2016 i i, 1/22/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller J a ate(MM/DD/YYYY)
F.ocBUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
ottA.Clark ' JAN 2.5 2016
yer f-Nam as ap ears on conveyance document Buyer 2-Name as appears on conveyance document
I
i 1(` t ill N r
Add s Number and Street1 ` I'-. ' Address(Number and 7/ —
IN �1�rbC-1).3 j
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
Y NO CONDITION NO CONDITION
i7,
❑ 1. Will this property be the buyer's primary AR / ❑ 3. Homestead
residence? Provide complete address of primary
residence, including county: ❑ c • ` • - - •y Heating/Cooling System
❑ 0 5. Wind Power Device
8308 W 475 S
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville, IN 47665 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,S to IP Code County ❑ 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
. . . .. . .. .. .
Address(Number and Street)
AL - /7 -o2 — /00 - 00 Y. 0/5 -CV/
City State ZIP Code County Primary property owner contact name E-'ail