Homestead_Graper (3) 7 �
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
EI PREPARElIblta s�Lr W- to - t
Becky King Closing Services
Preparer of the Sales Disclosure Form • Title
7820 Eagle Crest Blvd.,Ste 201 ' Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 becky.kinqeregionaltitlellc.com
City,State and ZIP Code Telephone Number E-mail
.EI SELbEFOI/GRANTOR(Sjt ' rlfl! Th Oft SL L wr i t .s CA I
I Iriah B Smith
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
501 N Willard St
Address(Number and Street) Address(Number and Street)
Fort Branch.IN 47648
Under penalties of erjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ',m� � ed by and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
A A
e Signature of Se er Signature of Seller
Uriah B Smith 02/03/2017
Printed Name ofpeller Sign Data(MM/DD/YYYY) Printed Name of Seller i ate(MM/DD/YYnt
:F BUYERS'GRANTEE($] APP,liIC9TIONr$Oa2P,,ROP,ERT FARDEDUCTIONSEIDENT1FiWALi$ C `'.I• i•TjA Y •
/Dvnght D Grapey i �-
1 rs on conveyance document Buyer 2-Name as appears on conveyance document 2017
604 Tretter Park Dr. FEB 6
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648
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 CONDITI
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary U ra 4.So eating/Cooling System
residence,including county: ❑ 0 5.Wind Power Device
501 N Willard St
Address(Number and Street) ❑ p 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ Fl 7. Geothermal Energy Heating/Cooling Device
City,State ZIP ode County
NI
n 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Fl 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)
a 4
City,State ZIP Code County
G —jc- i '- 3e/ - ooO. `,'o -ox
Primary property owner contact name E-mail