Homestead_Bolhofner 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)I GRANTOR(S)
ReHeld Parke 1 s q, , ,L:• C- $�`•�1 IV al 9es on conveyance @_NO LI V 11 \1- ��-
Seller 1-Name as appears on conveyance doc merit Seller 2-Name as appears on co document J
587 S Curtice Lane 587 S Curtice Lane
Address(Number and Street) Address(Number and S, jit ' !
Princeton, IN 47670 Princeton, IN 47670
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowl-• •.;-I,.j -ipti.-11•5i is true, correct
and plete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real ,, • \ • 4• -cA W6
r 1 Da N.)-\0-1 Ae< _,��.�.,„ _ A (at,�.� C�o4tl � 1ce
Si nature of Seller - Signature of Seller t 1
Ronald G. Parke ft/') -1;��-re 9/29/2016 Susan G. Parke on tri l�l,f'e, 9/29/2016
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 APPLY
Kelly D. Bolhofner ONYU'1 Bol ` CV
Buyer 1 - ae as appears on conveyance document Buyer 2-Name as appea on conveyance document
5�?,)\Lm1 C-, r-y 1c ivei WI 3 Cw rid •B■vd
Address(Number and Street)t Address(Number and Street)
)< S1. Le (-1 S fcc) )
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
ES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary AO ❑ 3. Homestead
residence? Provide complete address of primary -❑ .7 la.. 4. Solar Energy Heating/Cooling System
residence, including county: "
587 S Curtice Lane ❑ )5. Wind Power Device
Address(Number and Street) 0 )13 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ /-i 7. Geothermal Energy Heating/Cooling Device
City, St te ZIP Code County ❑ Vii] 8. Is this property a residential rental property?
❑ 12. Does the buyer have a homestead in Indiana to be ❑ /-93 9. Would you like to receive tax statements for this
/v vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
a6 —lr —IS —o2On • ob1 . 8Do -C -7
City, State ZIP Code County Primary property owner contact name E-mail