Homestead_Goldbach (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER -
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 CHRISTINAOREGIONAL-LT.COM
City,State and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) -- - .
Marshane Bonaparte
Seller I-Name as pears on conveyance document Seller 2-Name as appears on conveyance document
)( 1� $ Cn /k4uoc>JAi'L.
A d (Number and Str t) / ( � Address(Number and Street)
,
Under pe Ities co_fst5rjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a comp ete as repair la : .'is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
I , L _
Signature of Seller ! `. )/� Signature of Seller
Marshane Bonaparte
Printed Name of Seller Sian Date(MM/oa/YYYY) Printed Name of Seller t Sig •-
F.B GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS TI - •, P(Y ? .
my
Chase Goldbach Kimberlee Goldbach
appears on conveyance docume B erg-Name as appears on conveyance document
(, SLu 6. 150 S. SEP 14 2016
Address(Number and Str dress(Number and Street)
THE SAL ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. DENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION • ON
❑ 1.Will this property be the buyer's primary I M ••.
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ is
1808 Cottonwood Dr 5.Wind Power Device
Address(Number and Street) ❑ Fl 6.Hydroelectric Power Device
Prin ton, IN 47670 Gibson ❑ IS 7.Geothermal Energy Heating/Cooling Device
a ,State ZIP Code 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 ❑ IS 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide Contact information
ncludin co nty: below.Please see instructions for more information.
a� C- 15b.' • 1 Not available in all Counties.)
^SAY (NUmbe.. Sweet)
T ,J _J-7 1 r 70 6-1,;(51A
d6, '!d 06 - ;oY -oo/• 5i8 - oat$
City,State ZIP Code County
Primary property owner contact name E-mail