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HomeMy WebLinkAboutHomestead_Smith (26) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.P,REITARER 4'•'.•-U - _—. --- -•Leon C.Stone President Preparer of the Sales Disclosure Form Tide 226 West Broadway Street Broadway Title,Inc. Address(Number and Street) Company Princeton, IN 47649 • (812)386-1687 btiemw.twcbc.com City,State and ZIP Code Telephone Number E-mail t _.� __ _ - -77-='7=-.- 'E:SELLER(SJ/,GRANTOR(S)E .j_�. `„_. .. .�• �_: __-, - - ,.� �._:__ -_IT- -= --.. «_ Ken A.Coburn • Steven M Coburn Seller I-Name as appears on conveyance document Seller 2-Name as appears an conveyance document 7133,Fble Road • - Premr,4-- /0/30 C'1-Qw44-er 20f0 Address(Number and Street) Address(Number and Street) Boonville IN 47601 Frans: e-!N--4 849 fi.)4.%5 if i Ile —Ev 4)7 23— Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and corn ete as require y I w,and is prepared in accordance with 1 6.1.1-5.5,"yyeal Property Sales Disclosure Act". Signature of Seller ignature of Seller l/,1{' Ken A Cohurn _/h-I Steven M.Coburn G/(y I i-7 Printed Name olSeller Sian Date(MM/DD/YYY) Printed Name of Seller Sian Date(MA/DD/YYY11 ;F.,BOYER(SJ%GRANTEE(S) APPLIGAT1ONiEORPROP,ERTt} TAkl EDOGTIONS_IDENTIFYouthITEMS=THATiAPP,L' _;-' _,I_ Matthew E.Smith _ � Buyerl conveyance appears on coeyronce document Buyerl-Name as appears an conveyance dacumen[ 209 South Third Street _ 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 APPLilrT �;�. YES NO CONDITION I YES NO CONDITION q (7] ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead G0/T residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling Syste 'Q residence,including county: 209 South Third Street ❑ rA 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Francisco, IN 47649 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ID VI 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 ❑ 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) City,State ZIP Code tl?-/3�9-07o�-er�msa • COS County Primary property owner contact name E-mail