HomeMy WebLinkAboutHomestead_Miller (5) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PRE�^PARER .
Fi/'-r->L'1.G/740.1 n?Zn CLOSER '
Preporero)the Smea u.,...mire Form Tide
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES. LLC
Address(Number and Sweet) Company
EVANSVILLE,IN 47708 812-468-8485
City,State,and ZIP Code Telephone Number E.mall
E:SELLER(S)/GRANTOR(S ' --- _r_,-_. - - - -- - _ :'"` '- '-:zn. -,_,r:.r'' q. _....
DUANE L El PERS CO-TRUSTFE I YNN A Fl PFRS CO-TRUSTEE
Seller l me as appears one nveyance document Seller 2-Name a rs on conveyance document
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Address(Number and Street) ress Num and t)' I1
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and co lete as required by law,and is prepared in accordance with IC 6 '.1- 1":� P�Jy Sales Disclosure Act".
Sign Sell t // Signa�fSeller '
x l ua %e L. 7 �r2eY� 5 le \inn l - �! iyS g-S- ► te
Printed Nome of Seller Sian Date(MM/DD/YYYI) Prim Name of Seller Si n Date(MM/DO/YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY.TAX•DEDUCTIONS-;IDENTIFY ALL:1[ li A'I) / ` , • •
I LISSA MILLER jl��--''I1 J��►kt-U--tt��
on conveygpr� nt. Buyer 2-Name as appears on conveyance document
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Addess(NumberandStreet) Address(Number and Street) "
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION a , , I VDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homes ':•
residence? Provide complete address of prim . a a o . - • - w -eating/Cooling System
re idenc ncludin county: ❑ S.Wind Power Device
) 0 Li &ie .a'--nSt�f
Ad (.VumberandStree [ ' q ❑ SI 6.Hydroelectric Power Device
et l4 Sra.cI t IIU LI 71c3-1 ❑ NI 7.Geothermal Energy Heating/Cooling Device
C crate ZIP a 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 ❑ 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)
C i t y,State ZIP Code County
A4 _is- 34 - %foA -000, 0 `7Y -cog
Primary property owner contact name E-mail