HomeMy WebLinkAboutHomestead_Brockman INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
--- --- - -7..- v r - _ ..
-D:PREPARERh s __-.. ..- _ _ _ ._ • — . ._,_ _.�' _ - t -,_J_.:'_ _ . . _. "ss. _._ ."�
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINAIWREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
. Y .y. •? � j i- Gam•:`fie
E:SELI:ER(S)/GRANTOR{S) ,:, r' °' _ :__ x � '. : r.-,
Kenneth L Conklin Deborah A Conklin
Seller I-N s appears on conveyance document ller 2—Name as appears on conveyance decumept
r- :1\ - p.63-e- Ai(vvdy= fel u F
Addtess(Numbena Street) A (Number and Street)
= =-i X�Address _6IfRETh i tmA 924 y7
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and mplete r q ed and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
gnature of Seller / Signature of Seller
—gyp
6 r
Kenneth L Conklin
f _r� `^ � Deborah A Conklin �� -- =- _'�99
Printed Name of Seller Sian Date(M.M/0D/Ym) Printed Name of Seller Sign Date(MM/ D/Ym1
;
_
THE SAL ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE HAT PL ,,%
�n DI of
YF 7L.NO- CONTION I I -YES-' ' aCONDITION ' r.
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead AUG 1 2 2016
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county:
S.Wind Power Devi
508 N West ❑ ,
Address(Number and Street) El 12 6.H 5 ydroelectatfto�e•
TY AUDITOR
Fort Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City. to ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be El ef 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ SI 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
• including cou ty: /� below. Please see instructions for more information.
V
tC U is E a k_e_ . 4—v--Q Not available in all counties.)
Address(Number and Street)
nvl1jSwe ti i. L-LU 477/I-/' (*Ado 491)0 Q -1 g- )3-yo&- coo ,IabM2
City,State ZIP Code County
Primary property owner contort name E-mail