Homestead_Gomez (2) I INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page:
I D. PREPARER
Teresa S. Holifield Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 teresa @swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Kathryn R. Mathis
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
806 E State St
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 ,
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
an complete as required quired by law, and is prepared in accordance with IC 6-1.1-5.5, 'Real Property Sales Disclosure Act".
Sign6ture of Salt- Signature of Seller
Kathryn R.Mat is 8/11/2017 8/11/2017
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL igt.g J £3 gex TAXATION
Subject to final acceptance for transfer
Cyi Nichole Gomez II''
Buyer I-Name as appears on conveyance document Buyer 2-Name as appearsaccare)114 document
115 W Water St
Address(Number and Street) Address(Number and Street • 1D
Princeton, IN 47670 fN -J
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF 04E T AT ELL—
YES NO CONDITION YES NO CONDITION ,hl tlaGt�.
0 El 1. Will this property be the buyers primary 0 ❑ 3. Homestead GIBBON COUNTY AUDITOR
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
806 E State Street
El El 5. Wind Power Device
Address(Number and Street) ❑ 8 6. Hydroelectric Power Device
Princeton, IN 47670 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, state ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 1/Y] 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
Xnm19- 1a-De- 103- 003.2 69
City,State ZIP Code County ary property owner contact name E-mail