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Homestead_Riggs INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER Bryceann Cutsinoer Preparer of the Sales Disclosure Form Title 226 W. Broadway St. Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 _ 812-386-1687 blemw.twcbc.com City.Stole,and ZIP Code Telephone Number E-mail 4 E.SELLER(S)/GRANTOR(S) Brian Ellis Kristen Fills Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 12112 Petersburg Rd 12112 Petersburg Rd Address(Number and Street) Address(Number and Street) Evansville IN Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". /--Y. rt-t t `+-1 sl )? QQ ii) Signature of Seller Signature of Seller Brian Ellis U Q /7 Kristen E lis :a r • Printed Name of Seller Sian Date IMM/DD/YYYY) Printed Name of Seller S i in IT anIF�'ir/YYYn F. BUYERS GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS "-A ° - - '.J i-' Dani I . Ri s Kimberly R. Riggs A(f 9 2017 Guyer t-nm-v. or up ars on conveyance document Buyer 2-Name as appears on conveyance document 501 W. Lincoln St. 501 W. Lincoln St. Address(Number and Street) Address(Number and Street) THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES _NO fl hniyhm_ Q ❑ 1.Will this property be the buyer's primary At ❑ 3. HomesteairTh residence? Provide complete address of primary 11 © 4. Solar Energy Heating/Cooling System residence,including county: 405 S. Main St. ❑ I51 5.Wind Power Device Address(Number and Street) ❑ Q 6. Hydroelectric Power Device Owensville, IN 47665 Gibson _ ❑ Q 7. Geothermal Energy Heating/Cooling Device city, ate 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 ❑ 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. 501 W. Lincoln St. Not available in all counties.) Address(Number and Street) Princeton, IN 47670 Gibson 6, -- / 7 - /r2 _ ;0 l{ - 000 . 0L-i0 - 0 ).. ) City,State ZIP Code County Primary property owner contact name E-mail