Homestead_Domes INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER _, _ .. .-. `. "' -_•-.. - `} -t F-r ati..t9:". .tea. 0* . . ^ s ==7"`g _—.;;5Y11--Y`i---
Bryceann Cutsincier
Preparer of the Sales Disclosure Form Title
226 W.Broadway Broadway Title. Inc.
Address(Number and Street) Company
Princeton, IN 47670 812-386-1687 bti D()mw.twcbc.com
City,State,and ZIP Code Telephone Number E-mail•
E.SELLERfS]fGRANTOR(S). _ - - .. '''.::::J.:.-5S.
Thomas W Hackler Ruth E Hackler
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
3097 F Curtice 1 ane 3097 F Curtice I one
Address(Number and Street) Address(Number and Street)
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 required by I w, is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
� E • -14-ed u eV . •
Signature of
Signature of Seller
T.o-.-..'wGFTMarrxa.— /s2/A 40/6 Ruth F.Hackler /1-2,2_-.20/La
•rin ted Name ofSeller Sign Date(MM/DD/YYYt) Printedkamee(Selec ion Date(M4/DD/YYn)
F.BUYER(S)/GRANTEE(S). 'APPLICATION FORPROPERTY,TAXD6Dl'1CTIONS='iDENTIFkICITEMSiTHATABP,L . -. __
Steven L. Domes (• Cecilia A. Domes - /
Buyer l-Name as• .-ars on conveyance document Buyer 2-Name as appears on •nveyance document - •
W. Mill Rd. ' f
Address(Number and Sweet) Address(Number and Street) 41 p 4
Evansville, IN 47710 Evansville. IN 47710
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TH I .,I PERT'. IDENTIFY ALL OFTH HAT APPLY. )yq t `
YES NO CONDITION YES NO CONDITION O/TO
'r
❑ L Will this property be the buyer's primary N Ir ❑
3.Homestead
residence? Provide complete address of primary II n , -e . • - a 'eating/Cooling System
residence,including county: ❑ 0 5.Wind Power Device
3097 E Curtice I ane
Address(Number and Street) ❑ f 6.Hydroelectric Power Device
Princeton. IN 47670 Gibson ❑ Z 7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ $ Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ (7 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.
("1 Not available a in all counties.)
Address(Number and Street) C�(Cr.I_/_I 5 _/00— .oga-oat
City.State ZIP Code County (X R
Primary property owner contact name E-mail