HomeMy WebLinkAboutHomestead_Burst INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D PREPARER. - t "-
Rexanne McCauley Title&Escrow Processing
Preparer of the Sales Disclosure Form Title
3930 Mezzanine Drive,Ste C Columbia Title, Inc.
Address(Number and Street) Company
Lafayette, IN 47905
E_SELLER(S)/GRANTORO : ...`:
Fstate of Patricia A Harvey
S 1-Name as appears on conve ance document Seller 2-Name as appears on conveyance document
MO C/»eoli ( r
A d ss(Number and Street) Address(Number and Street)
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".
Signature of Seller /� Signature of Seller
/
Carol A. Cox. Personal Representative r 0`��l'"/
Printed Name of Seller S{qn Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F BUY,ER(S)/GRANTEE(S)_=APPLICATION FOR'PROPERTY TAX DEDUCTIONS IDENTIFY ALL ITEMS THAT APPLY- _ '
Whitley N. Burst Atlee L. Cook
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance docum
507 West Christian Street 507 West Christian Street
Address(Number and Street) Address(Number and Street)
Princeton IN 47670 Princeton IN 47670 007 '
TH`A�TW Ly.Li
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YES NO CONDITION YES NO CONDITION STY 9
0 ❑ 1.Will this property be the buyer's primary Z El 3.Homestead ��b.,
residence? Provide complete address of primary ElWI 4.Solar Energy Heating/Cooling System
1 , residence,ireludjng tour
I�C f'/�,.� GI� �Q.K ❑ ❑�/ 5.Wind Power Device
A ess umberraandStreet) l� I ❑ 0 6.Hydroelectric Power Device
`� 1(nC IL) L�� )O ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑✓ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ YI 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) /
0��0- /o? 7 /a/oc/ /O 4 ga
City,State ZIP Code County
Primary property owner contact name E-mail