HomeMy WebLinkAboutHomestead_Ray (4) /
dNA SALES DISCLOSURE FORM SDF ID: Page 2
-
>HRISTINA LATHAM TITLE CLERK
J/ 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
. /
:EISECLER(S)/GRANTOR(S)t± ..1_-.7-2— . ..} :`-i' _ .._.,r 1. _. .1?' _J`;:...__ : 1' ' 's- '.".`73,t -."':cAi.:" .-'_,:
Delores,lean Conklin
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
A• 7o79 w 512 6a
Address(Number and Street) Address(Number and Street)
E74errc/
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete Maass require by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Darren McClellan Attorney \f //-3o ZO/4
Printed Name of Seller / Sian Date(MM/OD/M71 Printed Name of Seller Sian Date(M.M/DDAYYII
F.BU,YER(S)/GRANTEE(S).iAPPLICATION;F.OR•PROPERTY;TAX+DEDUCTI ONS-IDENTIF,Y;ALL'ITEMS:THAT,APPLY.;__._:_ -i,-.
Joseph M.Ray
aet I-A.mr S appears on conveyance document Buyer 2-Name as appears on conveyance d amen
DEC 1.2 2016
City State,and P Code / CID;State,and ZIPCode
Ai 4A;Jo-i 1/,r//� KY y2z/5
. Telephone Number / E-mail Telephone Number GIRO �t�( /�-- Email
THE SALES CLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPI.YU ate__
YES NO' CONDITION • NO CONDITI I.
❑ 1.Will this property be the buyer's primary Si ❑ 3.Homestead
residence? Provide complete address of primary --J 4.Solar Energy Heating/Cooling System
residence,including county: ❑
1104 S Seminary S.Wind Power Device
Address(Number and Street) ❑ 151 6.Hydroelectric Power Device
Princeton, IN 7670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,Stale ZIP ode 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 ❑ 12 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.
lot available in all counties.
Address(Number and Street)
) —la —/F—X0/—oov . ce o -o .-'
City,State ZIP Code County
my property owner contact name -mail