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HomeMy WebLinkAboutHomestead_Worthington INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 O:.PREPARER_ T, 414 r->Y 4 rl ,: a -x •4J Leon C. Stone President Preparer of the Sales Disclosure Form Tide 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company _ Princeton, IN 47670 (812)386-1687 bti(Tmw.twcbc.com City,State,and ZIP Code Telephone Number E-mail• E.SELLER(SVGRANrT)R(SJ. .:_ . ' ° _u-. == Terry Jackson I ee Seller I-Name as appears an conveyance document Seller 2-Name as appears on conveyance document 2300 East I eke Road 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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Seller Signature of Seller Terry Jackson I ee Printed Name of Seller Sian Date(MM/OO/YYYYI Printed Name of Seller Sian Date(MM(DO/YYYY) ;F:BUYER(S)%GRANTEETS)` APP.UCATION,EOR,.PROPERTY,TAX?DEDUCTIONS`IDENTIFYALL'.ITIEMSTHATAP,PLY -77 Clinton M.Worthington Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on conveyance document 2300 East be Road Address(Number and Street) Address(Number and Street) pp_ Princeton, THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFYA)ibOF T.of THAT APPLl.E2o/, YES NO CONDITION I YES NO CONDITIONS • [f ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead its�; residence? Provide complete address of primary ❑ © 4.Solar Energy Heating soling System residence,including county: ❑ Q "/T ?100 East Lake Road 5.Wind Power Device OR Address(Number and Street) ❑ 6. Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ I7i 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ ig 0 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. Not available in all counties.) Address(Number and Street) Z10- 17 -og -,Ro4iCl ba4 - o2g City,State ZIP Code County Primary property owner contact name E-mail