HomeMy WebLinkAboutHomestead_Cook INDIANA SALES DISCLOSURE FORM SDF ID: Paget
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Elizabeth Vance Lead Recording Coordinator
Preparer of the Sales Disclosure Form Title
809 Wright's Summit Parkway,Suite 200 PRISM Title& Closing Services,Ltd.
Address(Number and Street) Company
Ft. Wright, KY,41011 _ (859)344-2756 elizabeth.vance@prismclosings.com
CGp,State,and ZIP Code Telephone Number Email
IF!SFIVFR(SVGR%NTOR(Sly 71aE.c4 IDS fatatSialtICC:£Ssif` tattst'iYc uvicaratldta L erSiftgS31fst_:4-1.6,42 4:'Y1-P"i.AmaYr1.4HsrIliltitiit
Branch Banking and Trust Compan\_
Seller I-,fame as appears an conveyance dory tent Seller 2-Name as appears on conveyance document
110 South Stratford Road _
Address(Number and Street) Address(Number and Street)
Winston Salem,NC 27104 _
Email
Under penalties of perjury,I hereby certify that this Sales Disclosure,to be the best of my knowledge and belief,is true,correct and complete as required by
law,and is prepared in accordance with ICI-1.1-5.5,"Real Property Sales Disclosure Act",
Signature t 210 OC CI Signature of Seller
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Printed Name of Seller Sign Dare am DD'Y TT) Printed Name of Seller Sign Date(SLtf DD'YYYY)
+EaRIiyER(SVGRANTFE(Sl-=4APPLICATION 1PR DFDliG IONSANDCREDITS"-"IDENTIFYAL'LlITFEIS'THAVAPPLY 'k -'Ck--Is S:`3Flta>F1tUUh4IIfn
Gregory J.Cook
Brave/-Name as appears on conveyance doom is nt Buyer?-Name as appears o n nvesJe�ocur?e J
2420 Louisville Avenue
Address(Number and Street) Address.(Number and Street) JuL .! 2016
El Paso,TX 79930
cCity
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TIIIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
/
Ell I. Will this property be the be er's primary residence? Provide ICS n 3. Homestead -
IYY�,I complete address of primary ri;'dente,including county: ILn�J
/11 I 1 u) Pule,y St. /_(1..�,n A 4. Solar Energy Heating/Cooling System
1 Aan(ur/ugrtd 'trees) ,D ` H---a(T40111_1_v �Jdull ❑ Ire i 5. Wind Power Device
City State.and ZIP Code
v / n �uf 6. Hydroelectric Power Device
2. Does the buyer have a homestead to be vacated for this n 7. Geothermal Energy Heating/Cooling Device
nresidence? If yes,provide complete address of residence
vacating.including county: n S. Is this property a residential rental property?
9. Would you like to receive tax statements for this property
Address(Number and Street) via e-mail?(Provide contact information below. Please see
❑ instructions for more information, t\'ot available in all
Cm'.State,and ZIPCode County counties.) '1
e �v I_' Oa av
Priman'p� - t E-mail