Homestead_Ramsey INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2
iN.PREPARERT.- 7_- - -• _; — _ —
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number
E-mail
(VSEEEER(S)°/GRANTOR'(S)T ` ,.,
Richard D Henry Rachel C Stoll nka Rachel C Henry
Seller l-Name as appears on conveyance document Seller 2 ame as appears on conveyanred omen[
Boa n) M AI ti s-1-
X ao L fl `c�4) S--
Address(Number and Street) Address(Number and Street)
X raw evi s v ; I I f . /il L/770 to S XG e_cEq Me_. ,SN L\--7(0(c)
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 rGpuired by law,and is prepared in accordance(with-LC 6-1.1-5.5,"' -al Prop Sales Disclosure Act".
tJ 4 $ a. k ,
Signature of Seller le I Signature of Seller /
Richard D Henry 1112 3/ ) (a Rachel C Henry I�/a3/l�r
Printed Name of Seller Sian bate(M.M//DD/YYYY) Printed Name of Seller .,....Sian Date(M.N/DD/YYYFI
t F:,BU.YER(S)%GRANTEE(S)SAP.P:LICATiOI ORPROPERTIY!TAX�DEO.UGTIONSMDENTIt 1ATI M ITHArra E D —
Timothy L. Ramsey
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
r 7/720 li; 9SO s DEC 1.2 2016
Address(Number and Street) Address(Number and Street)
37.
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS . IDENTIFY ALL OF THOSE THATrA.. .
YES NO CONDITION NO CONDITION
❑ 1.Will this property be the buyer's prima I 10 ❑ 3.Homestead
X residence? Provide complete address of p •••. ear nergy Heating/Cooling System
residence,including county: ❑
202 N Main ST 5.Wind Power Device
Address(Number nd Street) ❑ 0 6.Hydroelectric Power Device
Owensville, 47665 Gibson ❑ jl 7.Geothermal Energy Heating/Cooling Device
Ciry,Staten 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 ❑ 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)
Ciry,State ZIP code ��_l7_/a- a -C�O0-aS-Oaa
Counry
Primary property owner contact name E-mail