Homestead_Grogan •
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 (
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Bryan E. Montgomery
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2723 S 350 E
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 ,
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 complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
VSigne ure of Seller ' i Signature of Seller
Bryan E. Montgomery 7/5/2019 . 7/5/2019
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYE- E(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL AT
,an
Buyer 1-Name as a.._- on conveyance document Buyer 2-Name as appears on conveyance document
1 r• e--, JUL 08 2019
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 ,
T- -: /1UDITOR E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUC •NS FOR THIS PROPERTY. IDEN ALL OF THOSE THAT APPLY.
YE NO CONDITION YES NO CONDITION
—❑ 1. Will this property be the buyer's primary 4$? ttJ 3. Homestead
residence? Provide complete address of primary el El 4. Sola ating/Cooling System
residence, including county:
❑ El 5. Ind lower Device
2723 S 350 E 0 El 6. Hydroelectric Power Device
Address(Number and Street)
Princeton, IN 47670 I Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City, StateSt ZIP Code County 0 El 8. Is this property a residential rental property?
❑ ( '--2-Does the buyer have a homestead in Indiana to be ❑ El 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete • •pe y via-- . Provide contact information
address of residence being vacated, including county: below. Please see instru for more information.
Not available in all counties.)
Address(Number and Street) Q f \91�/ c� -�
p1�lV� -i-- 00 -O ok _10t cm .
City,State ZIP Code County Primary property owner contact name E-mail
License/ID/Other Number