Homestead_Sampson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
CIi.PREPARER`'_ _ _
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 CHRISTINA(ThREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number
E-mail
- SELl_ a(SVGRANTOR(Sl: _ .. ,--
E
Maurice R Williams Karen Williams
Seller l'Name as appears on conveyance document Seller 2-M1pmeas appears o onveyance document
>C (0(c.3 i 5-fade 12Dcrd (r/ 5 N J/�Dl
Address(Number and Street) Address(Number and Street
X Ha le(-LO el IN H-7 b 4 3
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn lete as requir d-by lag nd is prepared in accordance with h IC 6-1.1-5.5,_Real Property Sales Disclosure Act".
tticn•-- `1,46- rte-' 440/1.1 it WILL/Lama)
Signature of Seller Signature of Seller �7
Maurice R Williams / .1 dj 7 l0 Karen Williams 49 -o/9,l 'l
Printed Name of Seller Sian Dote(.N,M/DD/YYYY) Printed Name of Seller Sian Date LN.N/aa/IY✓n
F::BU,YER(S)%GRANTEE(SAP.PL:ICATION FOR•PRO IERT.Y-TAX•DEDUCTIONSbIDENTIFY ALiLITEMS,THATAP..P.L V . _ _ _ ,_____
Deborah K. Sampson
Buyer I-Name as appears on conveys ce document Buyer 2-Name as appears on conveyance document
THE SALES ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA PLY.
YES NO CONDITION YES , 0 CONDITION fIBSON COUNTY AUDITOR
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary ❑ Q 4.Solar Energy Heating/Cooling System
residence,including county: ❑ ig
303 E Poplar St 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Ft.Branch,IN 47648 Gibson 7.Geothermal Energy Heating/Cooling
Ciry.State ZIP Code County ❑ gY Device
❑ ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 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) C 9�-I 9 - I 't�l -'o) - &OO• / q/-o roc
Ciry,State ZlPCode County Q. '/
Primary property owner contact name E-mail