Homestead_Tooley INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D?,P,RETARER-' . _ s.J- r e_., - _._.._, :;,..e i -, . .3- _ .s .::-Z.dL i,-- :'%,:;fita
THOMAS L.MONTGOMERY GENERAL MANAGER
Pr2parer of the Sales Disclosure Form Title - . .
101 PLAZA EAST BLVD.. STE. 102 TRUE TITLE SERVICE._ LLC
Address(Number and Street) Company
EVANSVILLE. IN 47715 812.402.6555 closingsOtruetitlein.com
City,State,and ZIP Code Telephone Number E-mail
r--�, -$ 74 a- : ,.r x: ,t. °_.,4 - - -.t,.:C ''a
ELIZABETH ANN HAIG, Personal Representative
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
106 E.Williams Street 106 E.Williams Street
Address(Number and Street) 4ddress(Number and Street)
Fort Branch,IN 47684 Fort Branch,IN 47684
State, ZIP Code Stare,and ZIP Code
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 I I Signature of Seller
ELIZABETH ANN HAIG_. P.R. / / 2018
Printed Name of Seller Sign Date(MM/DD/)TYI) Printed Name of Seller Sign Date(MM/0D/Yn9)
li BUYER(SS)7/GRANTI EEI STL-'ARPLIGATIDN1EO RROPER•Tt16TA•X4DEDUC-TIONS IDENTIEY ALL-�ITEMSITHATAEP.cYr.8_"• <`
EMMALEE H. TOOLEY TERRY R. RILEY
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
1200 W.4th Street 1200W.4 h Street
Address(Number and Street) Address(Number and Street)
Oakland City,IN 47660 Oakland City,IN 47660
- p. E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE I.
YES NO CONDITION YES NO CONDITION JUN 05 2C18
❑ 1.Will this property be the buyer's primary [ ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heatin Cool' S
residence,including county: p 5.Wind Power Devic (;
704 N. MAIN ST ❑ p 6.HydroelectnntBs eN_COUNTY AUDITOR
Address(Number and Street)
PATOKA. IN 47666-9513 GIBSON ❑ 8 7.Geothermal Energy Heating/Cooling Device
Gry,SmreZ Code County El fril 8-Is this property a residential rental property?
❑ j 2.Does the buyer have a homestead in Indiana to be ❑ El 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide
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 andSPeet) a6 04- a 4 3 oa- too. I 1 b-Dc 0
MM EE H. TOOLEY TERRY R. RILEY
City,State ZIP Code County ta„ •�r. ola w,er•, 4ename 0 -Dcc. , -b g 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
bein filed,)
$,c ,e w-7 , x 1-umg- ie4
Signature of Buyer] Signature of Buyer2/Spouse
'
EMMALEE H. TOOLEY /' q 2018 TERRY R. RILEY S / At( /2018
Printed Legal Name
Security{
License/ID/Other Number Number License/ID/Other Number