Homestead_Clark (9) INDIANA SALES DISCLOSURE FORM SDF ID: • Page 2
DyRREPARER7,X Tf W%Neff 'nee•* sa!s#.Sro4sW'n&F'. aliti.. . R: .:: 7i",tai' O[ litraiPAINSW.VerzaiiietaWC
Abbey Messel Closer
preparer of the Sales Disclosure Form Title
3101 N. Green River Road Suite 130 Columbia Title
Address(Number and Street) Company
Evansville, IN 47715 812-471-8563 abbev(hcolumbiatitlegroup.com
City,State,and ZIP Code Telephone Number E-mail
@Ei'SEGLER(Sjw/,GRA'NTOR(S)1 :=}°! ^".:-i-iii' $ilMI :''n:sSS1e` .
Randal Scott Helsley I eah K Helsley
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
5001S259E 5001S250E
Address(Number and Street) Address(Number and Street)
Princeton IN 47679
Under s enaltie of perjury I hereby certify that this Sales Disclosure, o the best of my knowledge and belief,is true,correct
and c ple[eI r• uirejjy�I�a ndis prepared in accordance withcC6-1.]-5.5,"�tga1 lnr Sa sl Disclosure Act".
• ! �.! K. /�l/a�1A f 1 ,V f�/,/)
Signature of Seller • �• re of Seller v/I
Randal Scott Helsley 4/3/2017 Leah K Helsley 4/3/2017
Printed Name of Seller Sian Date(•M/DD/rYY1) Printed Name of Seller Sian Date(MM/DD/Ytt11
1tFyBUYER(S)v/,GRANTEE(S) AP,PLI@ATIONAF,OR PRQP,ERTiYaTAX4DED.UCTIONSIDENTIFY � Et s IA t iE
( Benjamin 0. lark
•'•• • •.:.- • an conveyance document Buyer 2-Name as appears on canve4aprgI"I(da imeryL 01i
2011 Glenwood Drive HV
Address(Number and Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary fir0 3.Homestead
residence? Provide complete address of primary - U ❑j 4.Solar Energy Heating/Cooling System
residence,including county:
❑ 19 5.Wind Power Device
Address(Number and Street) ❑ z 6.Hydroelectric Power Device
❑ 0 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIP Code County
❑ IZ 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 ❑ Ej 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) ^/ n •�
City,State ZIP Code County
Tje -//-I. - 1°3 - 00a . /4 /- 0 �8
Primary property owner contact name E-mail
•