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HomeMy WebLinkAboutHomestead_Campbell (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 Leon C. Stone President Preparer of the Sales Disclosure Form Title 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 (812)386-1687 btiemw.twcbc.com City,State,and ZIP Code Telephone Number E-mail !E:SEELER(S)'/.GRANTOR(ST,__ — .--.- --. . - - - r ] Shannon D.Chaney Seller I-Name as appeors on conveyance document Seller 2-Name as appears on conveyance document 711 Polk Drive Address(Number and Street) 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 omplete as requ ed by 1 v,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Seller / / Signature of Seller Shannon fl Chaney l/// 9-/5-1--/i Printed Name o(Seller Sian Date(MM/DD/YYYY) Printed Name o(Seller Sian Date(MM/DD/YYYi f.:,BUYER(S)I/.GRANTEE(S)i :APPL'IGATIONjFORTP.ROP.ER'fsYiTAX~DEDUCTIONSkIRENTIFY=AEL•[TEMS THAT PO ,:• _ ] Michael N. Campbell Abigail M. Campbell Buyer I-Name as appears on conveyance document Buyer Z-Name as appears on conveyance document • 816 P Street 816 P Street n \-- Address(Number and Street) Address(Number and Street) t' Bedford, IN 47421 Bedford IN 47421 C' THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.4, YES NO CONDITION � YES NO CONDITION s/v/TO 0 ❑ 1.Will this property be the buyer's primary 7j ❑ 3. Homestead R residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 5.Wind Power Device 731 , Polk Drive Address(Number and Street) ' ❑ 0 6. Hydroelectric Power Device Oakland City, IN 47660 Gibson ❑ 1 7.Geothermal Energy Heating/Cooling Device City,State 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 ❑ Ill 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) / n d‘-/$4-(265- Old. t�"/ — w City,State ZIP Code County Primary property owner contact name E-mail