HomeMy WebLinkAboutHomestead_Bengert INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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ID-;l?RSP.ARER w ' Y 34 ,E7.C.,, .7—nr. ar=: 1-777 .:,:u.—i - o_:TT—71
THOMAS L. MONTGOMERY GENERAL MANAGER
Preparer of the Sales Disclosure Form Title
101 PLAZA EAST BLVD.:SUITE 102 TRUE TITLE SERVICE,LLC ' - - -- ' .
Address(Number and Street) Company
EVANSVILLE. INDIANA 47715 812-402-6555 closincis(aftruetitlein.com
Cig;State,and ZIP Code Telephone Number E-mail
?E:SECBER[S)/GRANTOR(S)_, w
SCOTT ANDREW WAI DFN
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
204 N 4RD STRFET
Address(Number 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 co j - • • i` , by law, . • • .Jr pared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Stature of Seller Signature of Seller
SCOTT ANDRFW WAI DFN 01/ 15 /2016
Printed Name of Seger Sian Date(MM/Oa(YYYY) Printed Name of Seller 5 YSian Date(MM/DanYYY)
iFiBUYR(SVGRANTEE(V APP LICATIONW,ORP,ROPERTY/TAX,DEDUGTIONS IDENTIFWA t R - ' ':
_�y,_
STEPHANIE M. BENGERT
Buye rI-Name as appears on conveyance document Buyer 2-Name as appears on conv ceC
AOddress(NuumDber and Street) Address(Number and StJGl]35ON COUNTY AUDITOR
OWENSVILLE, INDIANA 47665
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P F THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary I 0 ❑ 3.Homestead
residence? Provide complete address of prima y 4.Solar Energy Heating/Cooling System
residence,including county: ❑ IN
204 N. 3RD STREET. S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
OWENSVILLE.INDIANA 47665 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ B.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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)
STEPHANIE M.BENGERT
City,State ZIP Code County
Primary properly owner contact name E-mail