Homestead_Richard INDIANA SALES DISCLOSURE FORM SDF ID: 2019 Page 2
D. PREPARER
Kristina Watson Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (
E. SELLER(S)/GRANTOR(S)
•
Jonathan Ziliak Laurie Ziliak
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2072 W 1300 S 2072 W 1300 S
Address(Number and Street) Address(Number and Street)
•
Haubstadt, IN 47639 Haubstadt, IN 47639
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 y 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 isclo ure Act".
S ature o/Seller ✓ Signa ure of Seller /
J athan Ziliak TQ /_7- -, Laurie Ziliak se.
Printed Name of Seller Sign Date{MM/DD/NYYY) Printed Name of Seller Sigt Dat (M D/YY )
UYER(Sj1GRANTE S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Robert A. Richard Connie S. Richard rv1 o D
Buyer 1-Name asap conveyance document er 2-Name as rs on convcgg� met
5938 W 800 5938 W 800 S
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665 Owensville, IN 47665 MAY 0.9 2011
elepf(one;Number— r^
R�O.�.t1 COUNTY '1�1
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIF r1 1RM PYHOSE THAT APPLY.
YES NO CONDITION , S NO CONDITION
OW 0 1. Will this property be the buyer's primary P 0 3. Homestead
residence? Provide complete address of primary _____i_ _ - gy Heating/Cooling System
residence, including county:
❑ 5. Wind Power Device
2072 W 1300 S
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Haubstadt, IN 47639 j Gibson ❑ cIe:z..-7. Geothermal Energy Heating/Cooling Device
UState ZIP Code County ID8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ III- Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
5q'jG 5s��-�5 Not available in all counties.)
Address((Number and Street)
C t \S,,V _ - 2V\ `1K-OU C G b -7 dd-tea-, -J00- cam. '14 oaV
City, State ZIP Code County Primary property owner contact name E-mail
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