HomeMy WebLinkAboutHomestead_Campbell (3) 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)
Robert D. Ziliak Laurie R. Ziliak
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
8848 S 100 W 8848 S 100 W
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
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 require• by law, and is prepared in accordance with IC 6-1,1-5.5, "Real Pro e Sales Disclosure Act".
Signature of Se - Signet re of Seller
Robert D.Ziliak 11/18/2016 Laurie R.Ziliak 11/18/2016
Printed Name of Seller Sign Date(MM/DDNYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)IGRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Brandon Campbell 11��
Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on conveyance do ent �`
8266 Saint Johns Rd 6Q tsy
Address(Number and Street) Address(Number and Street) °•P
Elberfeld, IN
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TH I',:;:y-4 .•
YES, NO CONDITION YES NO CONDITION 4/,�
❑ 1. Will this property be the buyers primary 7cv ❑ 3. Homestead 7T0ff,
residence? Provide complete address of primary ❑ 4. Solar Energy Heating/Cooling System
residence, including county:
8848 S 100 W ❑ )' 5. Wind Power Device
Address(Number and Street) ❑ 1 6. Hydroelectric Power Device
'Fort Branch, IN 47648 I Gibson' El )2, 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ pp 8. Is this property a residential rental property?
❑ `t� , 2. Does the buyer have a homestead in Indiana to be ❑ 1Q„ 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete I 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)
Qt , -IS -RS-coo-Coy. ma-Das
City, State ZIP Code County Primary property owner con act name E-mail