Homestead_Short Jr INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER - - - - - T.
Jeff H. Bosse Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main St.Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville. IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) - •
Michael S Birch
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
III/l5emi'na 17 if
Address(Number and S Address(Number and Street)
Pain cr / Ill/ 9.7d70
Under penalties of perjury,l hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law, nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Ta. A e _
Signature of Seller Signature of Seller
Michael S Birch 12/16/2016
Printed Name of Seller Sign Date tMM/DD/YY»l Printed Name of Seller Sion Date(MM/DD/YYn]
F.BUYERS)/GRANTEE(S)-'APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALLITE { P- •PP, • i� - j
Samuel L.Short.Jr. Am.n.. h. 1
BuyerI-Name as a••-•. •. eyance document Buyer 2-Name as appears on conveyance document
3207 W.William St. 3207 W.William St. DEC 2 1 201G
Address(Number and Street) Address(Number and Street)
Champaign. IL 61821 Champaign. IL 61821
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
TA ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary Ill fg •• o ar ne z.t eating/Cooling System
residence,including county: ❑
S.Wind Power Device
Address(Number and Street) ❑ TA 6. Hydroelectric Power Device
City;tate ZIP Code County 0 7.Geothermal Energy Heating/Cooling Device
2.Does the buyer have a homestead in Indiana to be ❑ NI 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.
Address(Number and Street)
0 ( . u../S— /DO - ooy, 19S _ oA
City,State ZIP Code Cou -
.... E-mail