Homestead_Whitfield (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
1 c.7-777.�.�—
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 beckv.kinqeregionaltitlellc.com
Ciry,State,and ZIP Code I Telephone Number
E-mail
:E SELLER(S)'/.GRANTOR(S)t r_r— - ;irTP —i -e- _ .
I oris Helfrich Nancy Wilhite Blackard
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9981 SUS Hwy 41 112 S Damosa Dr
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ompleke as r uire by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
cSegnature of Seller (Q(gnawr of Seller
I oris Helfrich 05/25/2017 Nancy Wilhite Blackard 05/25/2017
Printed Name of Seller - Sian Date(MM/BD/m't) Printed Name a!Seller Sian Date(MM/DDf Yn1
FiiBUXER(S)/GI2F1\THEE(S)EAP,I?LIe:nioNthoRtBRopERTY6TAX1)EDUCTIONSI-clDENTIFY(AEMEMS,THAtaini,YI,; -, ;IL__
Tim A.Whitfield
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on cony ace cu eat
212 S 3rd Ave. • 1�"1
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL id mi tTVU yAUDITOR
YES NO CONDITION YES NO CONDITION
Q ❑ 1.Will this property be the buyer's primary 151 ❑ 3.Homestead
residence? Provide complete address of primary ❑ Q 4.Solar Energy Heating/Cooling System
residence,including county: ❑
702 S Fourth Ave S.Wind Power Device
Address(Number and Street) - ❑ 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ 51 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 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 ❑ IN 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-inail?(Provide contact information
inrluding county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
Gibson .L- \9 - 31 - 3b4 - c)cx-). 4k9L - 09
City,State ZIY woe County
Primary property owner contact name E-mail