Homestead_Bass INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Rocksan Underhill Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 rocksan @swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Randy L. Lough Alison M. Lough
Seller f-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1182 Case View Rd 1182 Case View Rd
•
Address(Number and Street) Address(Number and Street)
Dandridge,TN 37725 Dandridge, TN 37725
Under penalties of perjury, I 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".
(71(7/14 rii'-Signal --of.Seller:----"!' CSi ellerW,. ._."_"
Randy L. Lough 8/8/2016 Alison M. Lough 8/8/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT LY
7
Ryan R. Bass Samantha S. Bennett
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance docume t
2150 Fosters Way,Apt 16 2150 Fosters Way,Apt 16 4o,-,
Address(Number and Street) Address(Number and Street) 0 Is
Princeton, IN 47670 Princeton, IN 47670 C/qs
_
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TAO/APPLY.
YES NO CONDITION YES NO CONDITION /TOE
y ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ , 4. Solar Energy Heating/Coolino System
residence,including county: ❑ 5. Wind Power Device
344 S Address( ❑ 6. Hydroelectric Power Device
Address(Number and Street)
Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
!Oakland City, CitZPC47660 ?
Ciry, stare ZIP Code County ❑ `@"� 8. Is this property a residential rental property.
❑ �/2. Does the buyer have a homestead in Indiana to be ❑ br9. Would you like to receive tax statements for this
V property via-email? (Provide contact information
address for this residence residence? If cafe provide complete below. Please see instructions for more information.
address of rence being vacated, including county: Not availab//in all counties.) CO Address(Number and Street) CZ -/1/-07 V -00/51/- v 6
Primary property owner contact name E-mail
City,State ZIP Code County