Homestead_Haggard INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER+ = - f.r. " -
LANA C.HARPER CLOSER
I
Preparer of the Sales Disclosure Form Tide
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES,LLC
Address(Number and Street) Company
EVANSVILLE IN 47708 812-468-8485
City,State,and ZIP Code Telephone Number
E-mail
E.SELLER(5)/GRANT012(S).: :-i - Z.,.: .n - - ::::;":"AL- - :. _ 1 - - - . - - :.
CHART FS H CONF
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
533 L_t7-be (ao.4i. k( 0,--,
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as require' r w,a d i : 'pared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
4_ S___
S�,■raw-- Signature of Seller IF J i ]' I)
•nnted Name ofSeller Sian Dare(M.M/UO/YYYY) Printed Name ofSeller 1 Sign Date(MM/OD/YYY1)
F.BUYER(5)/GRANTEE(S ;-_APPLIGATIONFOR,P.ROP,ERTI'LTAXpEDUCTIONS:1DENTIFY;AEI.ITEMS,THATAPPCY'' 'a ' __:__- _._
JEFFREY L. HAGGARD MAR 3 1 2016
Buyer)-Name as a pears on conveyance d ument Buyer 2-Name as appears on conveyance document
KO (9b 7e (Z a� —
Ad era9s(Number and Street) ,/ n Address(Number and Street)
IA/'l(OAii P //J V759/ GIBSON COUNTY AUDITOR
THE SALES DISCLOSURE FORS?MAY BE.USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I NO CONDITION
TA ❑ 1.Will this property be the buyer's primary A ❑ 3.Homestead
residence? Provide complete address of primary . mar Energy I eating/Cooling System
//� r Sid ce,inc uding county:s.Uo � :;� ❑ 0 5.Wind Power Device
I Q�rss N �Str.- t)/ /N �/ �� /S�� ❑ 0 6.Hydroelectric Power Device
City,State ZIP Code Si L�� 4� bCounty ❑ 7.Geothermal Energy Heating/Cooling Device
4d `.Does the buyer have a homestead in Indiana to be ❑ 8.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) C/ _/ 47 3 Q3
City,State ZIP Code County
Primary property owner contact name E-mail