HomeMy WebLinkAboutHomestead_Moore (8) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Becky King Closing Services •
Prepare,of the Sales Disclosure Form Title
7820 Eagle Crest Blvd.,Ste 201 Regional Title Services
Addtrss(Number and Street) Company
Evansville,IN 47715 812-759-5555 beckv.kingeregionaltitlellc.com
City,State and ZIP Code Telephone Number E-mail
1 Ei S EE ilElt(S)7 G ltAN TO El S tleina-railitZ-S.Sai."--Saaerl:rig-i.Saf titTaYgitit0g- --7-4-k31:.4-tage-t_niaa---2:411
Michael S Wertz
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
506 N First St
Address(Number and Street) Address(Number and Street)
Owensville IN 47665
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
nd comple as re uir d by law,and is prepared In accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Sign ayte of Seller -4.-q--- 0 s7:26/4
Signature of Seller
Mich el S Wertz 03/240016
Printed Name ofSeller Sign Date(101/DD/YYM Printed Nome of Seller Sign Date PLWDB/21111
IP13INERISWGRANTEE(MtAPPLICATIONIEORlPROPERTAWAXlDEDIXTIONSMDENTIEWAIIIITEMS.ETHATIAPPLYaTnnZ.1
Crystal M L-1 Moore 1TM\
Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on cani.Pteicuint.1F1 1_,
4
612 W Brummitt St,
Address(Number and Street) Address(Number and Street)
MAR 2 8 2016
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OP THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
121 0 1.Will this property be the buyer's primary 12 0 3.Homestead
residence? Provide complete address of primary 0 0 4.Solar Energy Heating/Cooling System
residence,including county:
111 151 S.Wind Power Device
506 N First St
Address(Number and Street) 0 Fl 6.Hydroelectric Power Device
Owensville,IN 47665 Gibson 111 12 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
2
0 4 8.is this property a residential rental property?
Ill 1 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 0 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)
&6- 11-01 - 909- 000 .499- 6a
City,State ZIP Code County
Primary property owner contact name E-mall
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