Homestead_Simmons (8) INDIANA SALES DISCLOSURE FORM SDF ID: Paget
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Stacy Brown Closing Services
Preperer oftheSales Disclosure Form Tide .
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(✓✓umber and Street) Company
Evansville,IN 47715 (812)759-5555 closings`lareeionaltitlellc.com
City,State,and ZIP Code Telephone A'umber E-mail
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Christopher Scott
Sella i-Name as appers as conveyance document Seller l-Name as appears on or.eyan ILd . t
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428 N.Gibson St- I
Addrer(Number and Rosa) Address(Number and Street)
Princeton,N 47670 1111 3 0 znig
Number '"' E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my lIoageaan'rY$eYie';i£f iiffcorrect
and complete as required by law,and is prepared in accordance with IC 6-1.1-53,"Real Property Sales Disclosure Act".
Signore of Seller Signor a ofSeller
Christopher Scott
Printed Name of Seller Sign Dare(MM/DD/rm Printed Name of Seller Sign Date(MM/DD/IT1)
`-R7itlYERfSlIGRANTEE(S1"'APPLICATION-FORiPROPERTI AXDEDUL-TIONS-''IDENTIFY?ALInTEMS;THAVAPPLYat.+2 tEr_:.-ra _
Michael C.Simmons Katherine L.Simmons
av/e:l-Name as appears on conveyance document - Buyer 2-Name as appears on conveyance document
15777 Bolesta Rd.Lot 67 15777 Bolesta Rd.Lot 67
Address(hember andSmea/ Adorers(Number andStreef
Clearwater,FL 33760-3462 Clearwater,FL 33760-3462
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
!? ❑ 1.Will this property he the buyer's primary a' ❑ 3.Homestead
residence? Provide complete address of primary ❑ H 4.Solar Energy Heating/Cooling System
residence,including county: ❑
1 li E.Walnut Street H 5.Wind Power Device
Address(Number end Street) ❑ H 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ H 7.Geothermal Energy Heating/Cooling Device
Gry,Sax VP Code County 8.Is this roe a residential rental property?
❑ [� 2.Does the buyer have a homestead in Indiana to be ❑ property rtl '
vacated for this residence? If yes,provide ❑ H 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?rProvide contact information nfor a
below-Please see instructions for more information.
including county:
Not available in all counties) �) ^\/y •
Address(Number and Street) 9(, --t a-o �' '1 yb-®_/,{
? - !D 4.1.1 l-1(J f•C CCU11
G:7,5m2 ZIP Cade County Primary propary onmer contact mane E-mail .