Homestead_Carlock L INDIANA SALES DISCLOSURE FORM SDF ID Page 2
Timothy Shea Closing Services
•
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
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Scott A.Clark
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
8308 W 475 S
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665
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 c mplleett as required by law, nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
a•
gnature of Seller I Signature of Seller
Scott A. Clark (0/31
Printed Name of Seller Sign D to(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
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Chase L.Carlock Calah D. Carlock
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
11326 North Street 11326 North Street
Address(Number and Street.) Address(Number and Street)
Cynthiana,IN 47612 Cynthiana,IN 47612
nl�I E- all
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT API,LIQ.V 0 1 2019
YES NO CONDITION NO CONDITION
❑ 1.Will this property be the buyer's primary YES ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary ❑ to 4.Solar Energy Heating/Cooling System
residence,including county: ❑ (ZE 5.Wind Power Device
8308 W 475 S
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Owensville IN 47665 Gibson ❑ Q }(Geothermal Energy Heating/Cooling Device
City,State zi•Code County ❑ 8.Is this property a residential rental property?
❑ Qi 2.Does the buyer have a homestead in Indiana to be ❑ Q 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide
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) 26-17-02-100-004.015-021
Chase L. Carlock Calah D. Carlock
City,State ZIP Code County Primary property owner contact name E-mail