HomeMy WebLinkAboutHomestead_Wallis (5) INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2
D.PREPARER _
Laura Rininger Closing Services '
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services,LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 ramie.smith(Wregionaltitlellc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER{S)/GRANTORS) _ .
Diane M Cowling
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
604 S North St
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
anQ complete as a/rs s re aired by law,and is prepared in accordance with IC 6-1,1-5.5,"Real Property Sales Disclosure Act".
Signature Seiler L¢{ Signature of Seller
fliane M Cowling 09(13/2016 . s
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller t `/YYYY)
- .
F.BUYER S GRANTEE S '-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEM•`-' HA • 'ELY ' . ,,
Jerry Robert Wallis Nikki Jo Wallis �EP 1 5 Z�j6
.. . . ...- .n conveyance document Buyer 2-Name as appears on conveyance docume
5340 S 175E 5340 S 175 E
Address ranch,r and Street) ort Address(Number and Street) 14
Fort Branch, IN 47648 Fort Branch IN
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES +^ c^smTley
I� ❑ 1.Will this property be the buyer's primary 0' 3.Homestead>
residence?-Provide complete address of primary ❑ 4.Solar Energy Heating/Cooling System
residence,including county: ❑
S.Wind Power Device
500 S Willard Street
Address(Number and Street) ❑ is 6.Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
oty,State Zl a County
111 2.Does the buyer have a homestead in Indiana to be ❑ 0 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.
Note • Si. .•
Address(Number and Street)
A6 -/9-/9- /0/ -DDO.698 -00.2.6
City,State ZIP Code County
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