Homestead_Miller (13) INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2
rD:P.REP,ARER- ._:_ ._ .__L,�_ �_ _ T _-•."----w
Karen S.Creek . Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville, IN 47708 812-421-4000 closinu.dept @ieffbosse.com
City,State,and ZIP Code Telephone Number E-mail
ESECLER(S)%GRANTOR(S]su �L__ _r .----_1�_. — — ' —�._£'�_t
Alex K Campbell
Seller I-Name as appears on conveyance document Seller Z-Name as appears on conveyance document
- /5210 Ar Le,
Address(Number and Street) Address(Number and Street)
• cc ,'// ,/ 4177/1—
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
•Signa tuurreeooffSSelll Signature of Seller
Alex K.Campbell
Printed Name of Seller Sian Date(MM/DD/Y1TY) Printed Name of Seller Sian
LM. D
f:B G' •i' E(S)'_=APPLICATION FOR PROPERTY TAX DEDU -- - : ° a ALL ITEMS THAT APPLY - _ Z
_Blake A. Miller Amber D. Miller ✓&'v �
Buyer I N. •s appears on conveyance document r' - .- •s appears on conveyance docunjyt p
-700 S.Lincoln Street 700 S. Lincoln Street O-/eSp 0116
Address(Number and Street) Address(Number and Street) C
Ft. Branch,IN
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION /i} YES NO CONDITION
IN ❑ 1.Will this property be the buyer's primary ig ❑ 3.Homestead
residence? Provide complete address of prima • ri to nergy Heating/Cooling System
residence,including county:
❑ INI 5.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Ciry,State ZlPCode coanry ❑ is 7.Geothermal Energy Heating/Cooling Device
❑ EA 2.Does the buyer have a homestead in Indiana to be El 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)
City,State ZIP Code County �� _/9/9/o/- Ow i 2j- 0'6
Primary property owner contact name E-mail