Homestead_Ford (2) INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2
iD:.P.REAARER• r _21-p. < _. , i• . , • _ >
Becky King Closing Services
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd., Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 beckv.king(Wregionaltitlellc.com
City,State,and ZIP Code Telephone Number E-mail
_Win,. ._. - . ._ . -- --'77^T,-----'7-- --._ -
E..SELLER(S)%GRANTOR(S): 3 ._r _ _; ,. _'--
I ogan C Rogers
Seller I-Name as appears an conveyance document Seller 2-Name as appears on conveyance document
701 S Flm Street
Address(Number and Sweet) 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
and cotgplet• i s re._ ired by la, and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Se ler Signature of Seller
Ingan C.Rogers 11/04/2016
Printed Name of Seller Sian Dare(M.M/DD/YITY) Printed Name of Seller Sian Date(MM/DD/YYYY)
:F^BUYER(SI/GRANTEELS F=APPLIGATIONTFOR_BROPER7iY- AVDEDUCTIONS I ENTITY`AL'L;ITEMS,THAT:AP,PLrY., _ w __a
Corey L. Hollen Ford 4(n
Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conve r ent
329 S 5th Avenue.Ant 6 L'Kr}®p
Address(Number and Street) Address(Number and Street) P
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALLDkf i/li< :ir PPLY.
V'6 NO CONDITION I YES NO CONDITION 0C/hrj,4.jr
r.
0 ❑ 1.Will this property be the buyer's primary 12 n 3. Homestead Y-40,
tai
residence? Provide complete address of primary ❑ SI 4.Solar Energy Heating/Cool System
residence,including county: ❑ ig
201 S Flm Street 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City.State Zl 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 n TA 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) 24_17_ /a-ao I --� y.23 o^.Q
City.State ZIP Code County I
Primary property owner contact name E-mail