Homestead_Martin INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER 4
t.
-
Britany N Barnes Searcher
Preparer of the Sales Disclosure Form Tide
226 W Broadway Broadway Title, Inc
Address(Number and Street) Company
Princeton, IN 47670 812-386-1687 britany.bti @mw.twcbc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)
Brian Ellis
Seller 1-Name as appears on conveyance document Seller 2-Nome as appears on conveyance document
12112 Petersburg Rd.
Address(Number and Street) Address(Number and Street)
Evansville, IN 47725
Under penalties of perjury,t 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".
471- 1) O-4(
Signature of Seller Signature of Seller
Brian Ellis SJ6/ e20I i
Printed Name of Seller /Sign tate(MM/DD/YYY) Printed Name of Seller 'an Date(MM/DD/YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY DEDUCTIONS=IDENTIFY DENTIFYA T HA' 'P _ ,
Joshua C. Martin
o.ry-e:1-aalne as appears on conveyance document Buyer 2-Name as appears on conveyance document
303 W spfucu S+ MAY 9 2016
Address(Number and S et) p Address(Number and Street)
PP:
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES ,..--NG---EONINT40.14--�
0 ❑ 1.Will this property be the buyer's primary g✓ ❑ 3.Homestead
residence? Provide complete address of primary / p 4.Solar Energy Heating/Cooling System
residence,including county:
3586 N 175 W ❑ 12 5.Wind Power Device
Address(Number and Street) ❑ 12 6. Hydroelectric Power Device
Patoka, IN 47666 Gibson ❑ 12 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ® 2.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 ❑ 12 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°vailab - '. . . .
Address(Number and Street)
a? (.0 - oLi - a3 - vCo - ot I. 074 -oi ,
City,State ZIP Code County
Pri- . ,.,, . . • taclname mail