Homestead_Patmore INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER ,
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE,IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT.COM
City,State and ZIPCode Telephone Number E-mail
E.SELLERS)/GRANTOR(S) -
' Jack Farl Norris
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
4- 75-57 S 9 c 1-0
Address l(Number and Street) T11 (.) / I Address(Number and Street)
DWet1S 0 i Ie / I %I 17to Cc 5—
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and com ete as requt ed by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
f /� ,
Signs re of Seller
4 �(y� _ Signature of Seller
,lack Fad Norris �t �T-17 �''�
Printed Name of Seller Sian Date(MM/DD/r/YY) Printed Name o Seiler p �Si Da xx/DD
F.BUYER S GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL IT S
Zachary A. Patmore
Buyer 1-Name as•• - an conveyance d ment Buyer 2-Name as appears on conveyance dokitlit 0 101)
/` �tddrq Number and Scree° j_ �� Address(Number and Street)
/X` /700_4 / �Ce r,n-le T ,
THE SALES SCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY: DENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES _ • : I 's ITION
❑ 1.Will this property be the buyer's primary G ❑ 3. Homestea.
residence? Provide complete address of primary ❑ ig 4.Solar Energy Heating/Cooling System
residence,including county: ❑
S.Wind Power Device
_507 N Main St
Address(Number and Street),-_ ❑ 1g 6. Hydroelectric Power Device
Ft. Branch;IN 47648 Gibson ❑ IS 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIPCode County
❑ ❑ 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 ❑ 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)
24 ,- /8-I3youa _ 000. g3o -o a4
City,State ZIPCode County
Primary property owner contact name E-mail