HomeMy WebLinkAboutHomestead_Smith (4) INDIANA SAKES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER • i
CHRISTINA LENFERS CLOSING AGENT
Preparer of the Sales Disclosure Form Tide
501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) .
ROBIN I COOK DORIS A COOK
Sfjkr I-Name as apgootrs on conveyance document Seller 2-Name as ap rs on conveyance document
DAL() cratc.� C Shea
Addukss(Number and trV Lt 11 /� 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 con /ere as re red and is prepared in accordanc ti IC 6-1.1-5,5,"Real Property Sales Disclosure Act".
07 /,
r
ignare of Signature of N
ROBIN L COOK 06/08/2017 DORIS A COOK 06/08/2017
Printed Name of Seller Sian Date(MM/DD/YYYYI Printed Name of Seller ice(MM/DD/YYYn
F BUYFRtS).1ccRRAN[EE(S)r APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL I ' 1/ if
SEL.BISHA A. SMITH KEVIN L. SMITH
-,ame as appears on conveyance document Buyer 2-Name as appears on conveyance dgpyp 011
enj;5 J 2
11966 NOBLES CHAPLE RD SAME JJ UU 1I L I
Address-(Number and Street) Address(Number and Street)
ELBERFELD IN 47613
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES O CONDITION � ,,,YESS . , .t ,e ON
❑ 1.Will this property be the buyer's primary /'VI ❑ 3. Homestea.
residence? Provide complete address of primary ( S ill 4.Soar nergy •eating/Cooling System
residence,including counts. I I/
3 S . 0O✓,f'v-bOSQ Ur , ❑ l�y-�(� 5.Wind Power Device
Aft(Number dSo-e2)_ / t, xis i Lt74,346%4OSON ❑ L`� 6. Hydroelectric Power Device
�'7 "�( � ❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP a County
El 2.Does the buyer have a homestead in Indiana to be ❑ 1 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ tom' 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) q
AI -I3' --310 - Ho3 - 000, b `1 S- D°/
City,State ZIP Code County
Primary property owner contact name E-mail