Homestead_Starkey (2) 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 I
E'SFrLLERIS]7GRANTOR4S) n- '77,:. 'r :_T 7 :J- FY _ _ .' ._ _ :i'_ ,_ ,a . q— _
R.Quentin Niger
Seller l-Name as appears conveyance document Seller 2-Name as appears on conveyance document
trays conveyance document
`Addrest(Number an Sireet)0 I Address(Number and Street)
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E-mail Telephone Number Email
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Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and comp) to as re aired by law,and is prepared in accordance with IC 6-1,1-5.5,"Real Property Sales Disclosure Act".
tnreofSelllr I Signature of Seller
R.Quentin Higa
Printed Name oLSeller Cionta[eiMM/DD/11TI)t Printed Name of Seller Sian Date(MM/DD/n111
r.;BU AYE R(S)/GRANITEE(S)txAP•PLIC'ATIOMF.0R P,OaRTiYZTAXiDEDUCTIQNS6IDENTIFWALL!ITEM SAT:HATIAPPLy1F- , ;•-.,, .;Cvc`
Jaymes'N.Starkey �t++��''''�� ''^T,
buyer], Name as appears on conveyance document Buyer 2-Name as appears on conveyance docume��� �! t`
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`C}ddress(Numbe a }[ee)> Address(Number and Street)
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xutF inter ndZJPCC8d City State,and ZIP Code
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E-mail Telephone Number Email
THE SALE ISCLosuRE FORM DIAL"BE USED TO APPLY FOR CERTAIN'DEDUCTIONS FOR THISS PROPERTY. ID \TIF1'ALL OF THOSE T"431gNeN COUeRiNTY AUDITOR
YES`No— 'rt'CONDITION] lt= Or—COYDITION71
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary ❑ ❑ 4.Solar Energy Heating/Cooling System
residence,including county: ❑ ❑ 5.Wind Power Device
2457 E.Top Hat Road
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Princeton, IN,47670 Gibson ❑ ❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
be ❑ 0 8.Is this property a residential rental property?
to
❑ ❑ 2.Does the buyer have a homestead in Indiana to be
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)
City State ZIP Code O'�- is—iO- too- ®oa. as o� 7
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
Number License/ID/Other Number