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Homestead_Gipson (2)
INDIANA SALES DISCLOSURE FORD? SDF ID: Page 2 :D:PREPAREal zv%�ec. .tintatn ;12;t-tt33j Ya :'� 1r�2Z't;Kqn eiN��:iiw+ �`r�e3' �. LANA C.HARPER CLOSER Preparer of the Sales Disclosure Form Title 5231 Oak Grove Rd., Ste.A TOTAL TITLE SERVICES, LLC Address(Number and Street) Company EVANSVILLE. IN 47715 812-468-8485 City,State,and ZIP Code Telephone Number E-mail .:E'SELTLER S- GRANTOR S b.-_-�_',�°�«". %u"`_'?.i- _s _."A- Cn �.`�-� rPrit;is -- Andrew B Burkett Seller 1-Name us appears on conveyance document Seller 2-Name as appears on conveyance document 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". Az7 _.___2a S-sfr Signature of Seller - , Signature or Seller Andrew B. Burkett _ PrintedN'ameo Seller Sign Date(MN DD/niY Printed Name a Seller Sian Date(M.N/DOfYn1 'F"BUYER(5yGRAl y`TEF.(SJ.„APPGICATIONeIOR`PROPER'T11,TAXIDEt).UCTIONS'.-IUENTIP,Y>AL°E41T,ERNSTFI AEPtata,. ;�� Ashley D_Gipson Buyer I-Nam pt conveyance document Buyer 2-Monte as appears on conveyance document 30 11TH m e�$ucF A ess(Number and Street) Address(Number and Street) \i`1DY�SIMU -----7,\....1- 471(0(a- 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 CONDITION• ❑ 1.Will this property be the buyer's primary 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/C in�S tem}-1 T D residence,including county: 1g !! ❑ 151 5.Wind Power Device Address(Number and Street) ❑ IZ 6.Hydroelectric Power Devicej1 N 0 4 2018 ❑ IZ 7.Geothermal Energy Heating/ ooling Device Lily,State ZIP.ode County ❑ 2.Does the buyer have a homestead in Indiana to be ❑ [7] 8. Is this property a residentia}y enfal vacated for this residence? If yes,provide ❑ 171 9.Would you like to receive t.•BB/ r this complete address of residence being vacated, property via e-mail: $r1 L1 cQgrrgi ME R including county: below. Please see instructions for more information. Not available in all counties.) Address(Number and Street) kp 1..0 fr V—, — \ x3 — tOes• a3\A- City,State ZIP Code County , Primary property owner contact name E-mail 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".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filet ) ..'' _4 /'.e 9 5.._ v_s Signature of Hu/1 a� Av Signature ofBuyer2/Spouse Ashley D Gipson ✓5- U Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security License/ID/Other Number Number License/ID/Other Number