Homestead_Langham INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER ' .
Kathy Masterson Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 kathy @swinland.com
City,State,and ZIP Code Telephone Number E-mail
I(E,yTSELLER(S)'/ f•TOR(S)
Quinith S. Pollock
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
354 S 180 E
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
v‘..--......_.
Under penalties of perjunbi hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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!Signnaaturroof!Seller/i.°-'i•-- Signature of Seller
Quinith S. Pollock 12/30/2016 12/30/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
E BUYER(S)/GRANTEE(S)^APPRLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
is ....,.._._..
David J. Langham Autumn L. Langham
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
112 N. Prince Street 112 N. Prince Street
Address(Number and Street) Address(Number and Street)
- Princeton, IN 47670 Princeton, IN 47670
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. NTIFY ALL OF THOSEE1 THAT APPLY.
YES NO CONDITION YES NO CONDITION
- ❑ 1. Will this property be the buyers primary • >41 ❑ 3. Homestead CiIBSON COUNTY AUDITOR
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Cooling System
residence, including county:
354 S 180E ' ❑ 0 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
' rinceton, IN 47670 Gibson
El El 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ El 8. Is this property a residential rental property?
❑ y° 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
/ vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) ato- I a-09 --3D D-O03- 691-0a7
City,State ZIP Code County Primary property owner contact name E-mail
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