Homestead_Merriwether •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
;D.:PREPARER'• " _' i- ., tT-7.1774-7717'. - —a-*—.
Karen S.Creek Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville, IN 47708 812-421-4000 closinq.dept @jeffbosse.com
City,State,and ZIP Code Telephone Number E-mail
E:SEGLER(S)/GRANTOR(S) -- ' "
Brian Ellis
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
/2// Z t'o'.i ae6 M.
Address(Numrand Street)
Address(Number and Street)
Caa,,'sril e,X,A, 977 oz-r
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
• /3"( (AY /D-• 3/-'1,
Signature of Seller Signature of Seller
Brian FIBS 10/31/2016 i it.. Ilk
Printed Name of Seller Skin Date(M.M/0a/rY1) Printed Name of Seller & ., •.t3 MS. a/mn
'F:'BUYER(S)/GRANTEE(S),_APPLIQATION F.OR'PROPERT.Y TAX DEDUGTIONSOCiENTIF7:AL•I:■ITEMS-THAT AP:PlY+,3 r ._
Zachary Meriwether NOV 7. 2016
Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on conveyance document
C.3IBSON
404 N.Spring Street j
Address(Number and Street) Address(Number and Street) 7Lnrinlii
Princeton,IN 47670
COUNTY AUDITOR
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THI 'TY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 3.Ho a. tead
residence? Provide complete address of primary 4 4.Solar Energy Heating/Cooling System
residence,including county: ❑
404 N Spring Street 5.Wind Power Device
Address(Number and Street) ❑ is 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City:State ZIP Code County
❑ ❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 B. 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)
a(0--I I I a au4 c3.005 033
City,State ZIP Code County
Primary property owner contact name E-mail