HomeMy WebLinkAboutHomestead_Rexing (21) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D::PREPARER
Pam Hancock title administrator/closer
Preparer of the Sales Disclosure Form Title
221 NW Fifth St Lockvear Title. LLC
Address(Number and Street) Company
Evansville, IN 47708 812-421-8405 Pamela @lockveartitle.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) - • - , . - - •
DALE L. BELL DARLENE C. BURDETTE
Seller I'Name as appears on conveyance document Seller 2-Name as appears on conveyance document 1
1212 Mnl.r Rona 1515 Rid�ewood IZoold
Address(Number and Street) Address(Number and S eet)
EvolnSvi Ile, IN 41120 Fvoincv-ole,IN \I111Z
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and cam a as required by law rid is repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
( r6aer� ,(Pia,14a. c ,1',L2-
Signature ofSeller Signature of Seller
DALE L. BELL l i--1-1-1 DARLENE C. BURDETTE 1t-"1-11
Printed Name ofSeller Sign Date(MM/DD/YYPI) Printed Name of Seller �s--�J ,DIMM/DD/M7)F.BUYER(S)v GRANTEE(S)-APPLICATIONFORPROPERTY TAX DEDUCTIONS-IDENTIFYALLI S H AP
LOGAN R. REXING
yer - ame as appears on conveyance document Buyer 2-Name as appears on conveyance document
dc%2 1X611 C OWensvi Ik Rl NOV 1 3 2017
Address(Number and Street) Address(Number and Street)
HoMl.St/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary r 12 ❑ 3.Homestead
residence? Provide complete address of primary " L I U 4.Solar-Energy Heating/Cooling System
residence,including coyn ty:
fra 12G°I I C. Ow en sv i l le Rd El S.Wind Power Device
Address(Number and Sweet) ❑ 12 6.Hydroelectric Power Device
HAW,Sto k 'II.1 41GS9 C;i.,can ❑ 13 7.Geothermal Energy Heating/Cooling Device
City.State Z Code County
IN
(1) 2.2.Does the buyer have a homestead in Indiana to be Li 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 13 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) o.A y
A (0 - 2A - IS - 300 - 000 . e _v.1/2e
City,State ZIP Code County
Primary property owner contact name Email