Homestead_Seib INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
DzPREPARER ,�,T :-,:,;' ..:... . ,:•1.1flS£:-.;-: :=5.1:2'.. r 7.-- 7 °_Rr -°w
• I
.♦ - -[ Closing Agent
' parer of the Sales Disclosure Form Title
501 Main St.suite 101 - Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708
City,State,and ZIP Code Telephone Number E-mail
`E SELliER(SVGRANTOi2(S)` _'S�ti•-" '`s+ ,-eW`:W' . ugs$ °ae vsa" '.' '�r=`a � s' "
Karen S Holt
$ Ier I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
Y89 p 5 /%5175W
Address(Number and SDxt) Address(Number and Street)
Posey/0/12- /N 1/7G 33
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
ui
Signature of Seller /�.-,� II _I` Signature of Seller
Karen S Holt C0 "1LX1 Ika
Printed Name of Seller Sign to(H....i/OD/YYn) Printed Name of Seller Shin Date(MM/DOIYYM
FE"BUyYER(S)/,GRANTEE(SfrAP,P,L'i CATIONlF,OR'RROPERT,YITAX!
THE SALES DISCLOSURE FOILM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
U ❑ 1.Will this property be the buyer's primary ® ❑ 3.Homestead D
residence? Provide complete address of primary ❑ pj 4.Solar Energy Heating/ oo J... jI3 em
residence,including county: ❑
5.Wind Power Device FEB 1 1 2016
Address(Number and Street) ❑ 151 6.Hydroelectric Power Device
❑ 1g 7.Geothermal Energy He jfng/Co:lin_ le I :.
City,State ZIP Code County Ni
8.Is this ro erg ES1r r-• �'? 41 e e v
' ❑ 2.Does the buyer have a homestead in Indiana to be ❑ ❑ p p tijU COUNTY.
vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax s Is
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) (�
City.State ZIP Code County j` — I -1-3I- Soy - GOO-ate-D09
Primary property owner contact name E-mail