Homestead_Miller (13) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Tiffany Hoon Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville,IN 47715 (
Justin R.Graham
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
527 E 150 S.Road
Address(Number and Street) Address(Number and Street)
Princeton,IN 47670
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
a d complete as r quired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
12.
Ignature ofSeller ( � 1q Signature ofSeller
Justin R.Graham �ry1
Printed Name of Seller Sign Dat (MM/D/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
'NTEEfSI:?APPL1CA'rION FOR.PROP!Eititt WOEDUC- IONS_IIDENTIF.Y'ALI$tiITEMSrTHA�f'API'
Darlene Miller
uyer - ppears on conveyance document Buyer -Name as appears on conveyance document
11603 South Hazeltown Rd.
Address(Number and Street) Address(Number and Street)
Decker,IN 47524
Telephone Number FILED E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS ERO EP RTY.IDENTIFY ALL 0 HO THAT APPLY. Nov 15 2019
YES NO CONDITION 7/YES NO CONDITION
I❑ 1.Will this property be the buyer's primary IVO 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of prima ❑ Q 4.So ar mg/Cooling System
residence,including county: ❑
527 E 150 S Road Q 5.Wind Power Device
Address(Number and Street) ❑ El 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ Q .Geothermal Energy Heating/Cooling Device
City,StateZl Code County ❑ I,�,'/8.Is this property a residential rental property?
❑ 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, erty via a-mal?�Preul a contact information
including county: below.Please see instructions Or ore information.
Not available in all counties.)
Address(Number and Street) 26-12-20-100-000. 526-027
rlene Mi
City,State ZIP Code County Primary property owner contact name E-mail
Number License/ID/Other Number