Homestead_Benson , INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
!FSPREPARE :' . - .`'_� —= ; . _ mot.`
Sherri S Hudson Closing Manager
Preparer of the Sales Disclosure Form Tide
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 . 812-4214000 closinq.dept(a7ieffbosse.com
City,State,and ZIP Code Telephone Number
E-mail
DaSELL`ER(S)/GRANTOR( : ew "l - '. . ti. '- -3^ a :VS, -- '
Gary D Willis
Seller I-Name as appears on conveyance document Seller 2-Name as a
ppears on conveyance document
c1/44c4s. Sfi,4.-1. O. S7
Addirs(Numberand Street) Address(Number and Street)
,ol/li411:, oe•, ..0 V7LLo
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Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and com t s requi' law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature ofSel Signature of Seller
Sary n His 7-11-17
Printed Name o(Seller San Doti(1-14/1411119-1 Printed Name o(Seller Sign Date(MM/OD/YYI'Y(
EaHUYEK[S)`/,GRAN7IFE(SC AP.PbI6ATI0N+FOR'PROE?ER`GYTAX+I)}?DUET[oNATMERTWAE'E FTEIC1Sa'FffftTlAPP,LILts-4'4 1_a _-a: -
Cameron W. Benson
Buyer I-Name as appears on conveyance document Bu 2-Name as yer ppmrs on conveyance document
330 East Harrison Street
p. .
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. if
YES NO CONDITION YES NO CONDm ON/Q 1J , COi/
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❑ 1.Will this property be the buyer's primary ❑ 3.HomesteacP4f c'r *i
residence? Provide complete address of primary O .",�,-,/
residence,including county: ❑ ❑ 4.Solar Energy HeaU?(t� Alb g em
❑ 0 5.Wind Power Device •-•0
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device -,
❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State Zl Code County r-,/
❑ 2.Does the buyer have a homestead in Indiana to be ❑ [+Q B•Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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 County
Z 43- I s-CR S QED CVO 7 90 co 5/
Primary property owner contact name E-mail