Homestead_Richardson (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Form Title
5231 Oak Grove Rd.,Ste.A TOTAL TITLE SERVICES. LLC
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-468-8485
City•State and ZIP Code Telephone Number
E-mail
iESSELILER'(Sf/.GRANTOR(S)S,_ ----- — --- -- - -
Rayburn D Dilbeck j�1(_`q Meda J Dilbeck
grl;h'q as uppeprsaAlon n ument r Seller 2-Name as appears on conveyance docC`nt
Ad 1 (Number and Street) tff/-` Address?um an Street/
1)1.x}-r AS(7k. [Lt, aJ ` \
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 law,and is repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
yp
Aga";of Seller Signature of Seller �
Rayburn D Dilbeck 'S — \ 1 Meda J. Dilbeck 5= \ I -1-1
Printed Name of seller Sian Date(MM/DD(rrrl) Printed Name of Seller T - I t '.n Date IMM/DO/vrrn
IF.BU,YER ,. F. TEE S AP LLICATIONiF,OR/PROP,ERTYGTAX<<DEDUGTIONSEIDEN;TIEVAt T.M;3 ;;:• ',:i�•'
Michael D. Richardson
j'ance document Buyer 2-Name as appears on conve}7l nnryt 2017
a4SS sp /,^ 91F O L
Address(Number and Street) fir'_ Address(Number and Street)
UNenSY11Li Ill. AI7 Lob S
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP TY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION --7Pp—Cp\p1T{O,y�
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of prima --17-171 4:Solar Energy Heating/Cooling System
residence,including county: ❑ N
5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
City,
State ZIP/!.ode County ❑ 0 7.Geothermal Energy Heating/Cooling Device
❑ L� 2.Does the buyer have a homestead in Indiana to be ❑ 0 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)
62 -i7 -Of- 'too -°°t/ • Aid -001/
City State ZIP Code County
Primary property owner contact name E-mail