HomeMy WebLinkAboutHomestead_Jewell INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
- EVANSVILLE, IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
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Seller�I-I- le as appgts on nee docu(ll{•ntt Seller 2-Name as appears on conveyance document
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Address(Number and Stree Address(Number and Street) - —
City,State,and ZIP Code City,State,and ZIP Code
E-mail Telephone Number 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 completeas required by law,and is prepared in accordance with IC 6-1,1-S.S,"Real Property Sales Disclosure Act".
0 �XS{gnatureofSeller Signature of Seller
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••auto name of seller Sian Date(see/DD/m) Printed Name of Seller Sian Date(11M/DD/YYYY)
IFMBUYER(TArtApiTEECgiAPP,LICATIONI IKIRROPERTtYLTODEDUCTIQNSlagDENITIFYMEILl]TEMSOHAalfiRRItYi
auyer I-Name as ap on conveyance document Buyer 2-Name as appears on conveys octlenf 1F,
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X0,ok Jean,* A,
Address(Number and Street) Address(Number and Street) SEP 2 72018
e'fAia,vtn'lil j IN 4-1-7141 -
Telephone Number GIPSON COUNTY AUDI FUR E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I NO CONDITION
ID 1.Will this property be the buyer's primary YES ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county:
I 8774 S Meadow Lane ❑ ❑✓ S.Wind Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Owensville, IN 47665 Dubois ❑ ❑✓ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑ 2.Does the buyer have a homestead in Indiana to be El 08.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ ❑✓ 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)
-17-2-43-100 -004526-021 .
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number `� S' e