Homestead_Dickens 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 (
mail
E. SELLER(S)/GRANTOR(S)
Bob WiII Ho'mesnlnc. nyndia'na'corporation
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10231 S. Pheasant Run
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
City,State,and ZIP Code City, State,and ZIP Code
E-mail Telephone Number E-mail
Under penalties i rjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and complete s re uired by law, an is repared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature of,Seller. ' 1 Signature of Seller
elhrtd b,.U)la vh/F5. 6/13/2019 6/13/2019
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller fir- 1Y1v11•± —.M/DD/YYYY)
/F.31,1Y (S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL IT S H11RI[T�.,gIFL�JP_I : ,
( Charles R. Dickens Terri L. Dickens
`� B rs on conveyance document Buyer 2-Name as appears on onveyannmacim9nQ(j jy
3409 Wood Duck Dr. 3409 Wood Duck Dr.
Address(Number and Street) Address(Number and Street) �I/11 "t ��A�
Evansville, IN 47715 Evansville, IN 47715 ae44ccU444t.P
City, State,and ZIP Code
Telephone Number E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO ROPERTY. IFY ALL OF THOSE THAT APPLY.
YES NO CONDITION Y S NO CONDITION
X res
❑ 1. Wir ro 1pia,ppertyyte the buy stprimary r ❑ 3-icHomestead
ldgri�ePr'ovide•com l? plete address of primary r't"u`it-
residence,including county: ❑ 4. ergy H ing/Cooling System
❑ a 5. Wind Power Device
10231 S Pheasant Run
Address(Number and Street) ElEl 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County 0 El 8. Is this property a residential rental property?
� fl2 Doesllhe buyerhavela+.homesteadhin yIndiana to be 0 El 9. 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: K. ins ntiesT rmom information.
Not available in all counties.)
Address(Number and Street)
6, `g- 36-3 ov-oo2 k 2 8 �-ok
City, State ZIP Code County nmary property owner contact name E-mail •