Homestead_Rosignol INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER- ..
Karen S.Creek Closing Agent
Preparer of the Sales Disclosure Form Tide
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville, IN 47708 812-421-4000 closing.dept @ieffbosse.com
Ciy,State,and ZIP Code Telephone Number E-mail
•E:SELLER(S)/GRANTOR(S) '. . • _-- .- ' . .
Randall Thomas
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1256 S 200 West
Address(Number and Street) Address(Number and Street)
Prinreton IN 47670
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 and and is accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller — Signature of Seller
Randall Thomas 01-I1-11
Printed Name of Seller Sian Date(AM/UDnllll Printed Name of Seller Sian Date(H.N/DOMTY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS=;IDENTIFY.ALL ITEMS THAT APPLY _ -
Chelsea L. Rosignol
Buyer I-Name as appears on conveyance document Buyer 2-,fame as appears on ranve}•an_Uo cull,
801 S. Prince Street
Address(Number and Street) Address(Number and Street) FEB 1 2017
Princeton, IN 47670
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
IN ❑ 1.Will this property be the buyer's primary al ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑
5.Wind Power Device
801 S Prince Street
Address(Number and Street) ❑ pi 6.Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
StaP lode County
2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? Ifyes,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) ,�-I g- (ry-lo - ao y/-Da 8
City,State ZIP Code County
Primary property owner contact name E-mail