Homestead_Taborn INDIANA SALES DISCLOSURE FORM SDF ID: 2019 Page 2
D. PREPARER
Amy Pollard 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-mail
E 'SELLER(S)/GRANTOR(S)
Katharine Hyzy
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12210 SE 19th Ave.
Address(Number and Street) Address(Number and Street)
Portland, OR 97222
City,State,and ZIP Code City,State,and ZIP Code
1�
LS 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 complete as required by law, n is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
£atureofSl Signature of Seller
Katharine Hyzy 4(p_•1/ . b/3
Printed Name of Seller •SIgn(DatA(MM/DD YYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. EE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL I p FACT AR'p�y
John R.Taborn pl p1J {1St '/
ppears on conveyance document Buyer 2-Name as appears on conveyance document
415 N. Main St. JUN 1 9 2019
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
City,State,and ZIP Code City, State,and ZIP Code
(
Tele••t' '•
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCT a •S FOR THIS PROPERTY. IDEN Y ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
3( ❑ 1. Will this property be the buyers primary / 0 3. Homestead
residence? Provide complete address of prima N . _.-.,err- -rgy Heating/Cooling System
residence, including county:
411 N Main St. • Eli 5. Wind Power Device
Address(Number and Street) 0 li 6. Hydroelectric Power Device
;Oakland City, IN 47660 I Gibson ❑ it 7. Geothermal Energy Heating/Cooling Device l
City,State ZIP Code County 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be 0 9. Would you like to receive tax statements for this
/� vacated for this residence? If yes, provide complete grope - al . foul t information
address of residence being vacated, including county: our. Please see instructions for mo ' ormation.
Not available in all counties.)
Address(Number and Street)
—114- IB -Lo -too. i- - (
Pn property ownercontactname E-mai
City, State ZIP Code County
R
i
License/ID/Other Number
1,