HomeMy WebLinkAboutHomestead_Williamson (3) INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page
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)I GRANTOR(S)
Lance Blankenberger
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9293 S 225 W
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 •
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
.. complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
. ILLt A ci.. .&!44 ..IC •—... _
_ignatur of Seller •••••- Signature of Seller
Lance Blankenberger 9/18/2017 9/18/2017
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 ITEMS THAT AP Y
Kurtis Dean Williamson Carrie Ann Williamson
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance documen
310E John St 310E John
(NSt S Ng--
Address(Number and Street) Address(Number and Street) FA2 "`,
Fort Branch, IN
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAJ APPLY
YES NO CONDITION YES NO CONDITION 0/T.
0 ❑ 1. Will this property be the buyer's primary 2 ❑ 3. Homestead R
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
9293 S 225 W
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Fort Branch, IN 47648 J Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
,tCCity, State ZIP Code County ❑ 2 8. Is this property a residential rental property?
y�' ❑ 2. Does the buyer have a homestead in Indiana to be ❑ 2 9. Would you like to receive tax statements for this
' 1 vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address ofsidence being vacated, including county: below. Please see instructions for more information.
31 o e J` -o Y/ Not available in all counties.)
•
Ad% TStre(Numbe et)
FrCt ° 1 r, ia a6/ X -0��County Primary property owner contact name E-mail