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Homestead_Fireline
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D;:PREPARERL. xg : t_b , • >IT : fat 3� A J hs$ , f ., - O 4a ;tn., w �ctFL r DEBBIE JACKSON TYPIST Preparer of the Sales Disclosure Form Title 530 FREDERICA STREET FOREMAN WATSON LAND TITLE,LLC Address(Number and Street) Company OWENSBORO,KY 42301 270-689-2424 DJACKSON©FW-LT.COM City,State,and ZIP Code Telephone Number E-mail 'hE:•SELLER 5 '.6RANTOR S ifi .'era ' ('Ri-7A5 ".,IC*t a..,.« ':ik £"-.. .a ...'. l-2—(kG�E'.zsi...lfal L*?wx? a {1t gat! 7'. AI ' - ,3 JARED A.SMITH TRACY N.SMITH tlfr/l-Na ass appears on conveyance dor.=en:,p S ter 2-Name as appears on conve ancedocument L S(/ O✓-C i1 a/C) 11� /�S(� Ole�I//129 /7 D Am.... Numberands eet) q--77 21/ (Number and Sweet) Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct an mplet s required law,and)s in accordance wi IC 6-1.1-5.5,"Real Property Sales Disclosure Act". 51 re ofSdierrl r(( K S(gna a ofSe ler Cr r"'r' JAR r D A. SMITH 09/15/2017 TRACY N.SMITH 09/15/2017 Printed Name of Seller Sion Date(MM/DDJYM1 Printed Name ofSeller Sign Date M.N/Do/YinY ,I1UYER(Sy GRANTEE(SM APPUIC ATIONtF.ORtP,ROP.ERTYsPAkDEDUGTION5–iDEtiTIFY'ALOITEMS'gHAT'APPliYs'B H.tlfMMt M CHERYL A.FIRELINE Buyer I-flame as appears on conveyance document Buyer Z-Name as appears on conveyance document 11832 SOUTH 150 WEST Address(Number and Sweet) Address(Number and Sweet) HAUBSTADT, IN 47639 (' .i • THE SALES DISCLOSURE FOAM MAY BE USED TO APPLY FOR CERTALN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE - YES NO CONDITION' I ITS NO CoNOrnON 0/, i • Mil ❑ 1.Will this property be the buyer's primary 0 9-❑ 3.Homestead RUA. residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling SystelQit0 residence,including county: ❑ al 5.Wind Power Device 11832 SOUTH 150 WEST Addre:r(Number and Street) ❑ 5 6.Hydroelectric Power Device HAUBSTDT, IN 47639 GIBBON ❑ a 7,Geothermal Energy Heating/Cooling Device City,State ZIP Code County . la p ❑ 2.Does the buyer have a homestead in Indiana to be ❑ B.Is this property a residential rental property? vacated for this residence? If yes,provide [1 © 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: be/ow.Please see instructions for more information. 5880 S. 1075 W. Not available in all counties.) /^�,r��/ Address(Number and Street/ GIBBON a �a•3D7'WI OWENSVILLE,IN 47665 ab- a_,a 303 City,State ZIP Code County CI Primary property owner contact name E-mail