Homestead_Broshears Jr INDIANA SALES DISCLOSURE FORM - SDF ID: Page 2
D.PREPARER
Kathy Masterson CLOSER
Preparer of the Sales Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company,LLC
Address(Number and Street)
E-mail
E.SELLER(S)/GRANTOR(S)
ert D.Reynolds Debra S.Reynolds
Seller I- e as appears an conveyance document Sell er2-Name as appears an concnyance document
10700 Titze •Rd, 10700 Titzer Rd.
Address(Numberand Stree7\ Address(Number and Street) `-'--
Chandler,IN 47610 `----, ChandlerjJl6
Cite Stare,and ZiP Code �� Et tote and ZlPCode
- robr63@ v.tl m
Telephone Number fi E-mail Telephone Number E-mail
Under penalties of perjury ereliy—certify that this SaIes—D-islure,to the best of my knowledge and belief, is true, correct
and complete as required-by law,and is prepared in accordance with ICT=11 "Real Property Sales Disclosure Act".
SlgnatuWiller Signature of Seller
rR:6liert D.Reynolds 01/03/2020 Debra S.Reynolds 01/03/2020
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F.)YE S)/G E -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
odney V.Broshears,Jr.
8 Warne-aseppearsan meet Buyer 2-Name as appears on conveyance document
17455.Old State Rd.
Address(Number and Street) Address(Number and Street)
Evansville,IN 47725
E-mail Telephone Number F I LED E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY DENTTrY ALL OF THOSE THAT -
YES NO CONDITION / YES O CONDITION
,.,/� Jan u7 z010
❑ 1.Will this property be the buyer's primary I! I ❑ 3.Homestead
residence? Provide complete address of primary eating/Cooli s
residence,including county: GIBBON COUNTY AUDITOR CB
CI5.Wind Power Device
12809 S.Sunset Dr. ❑ III,z 6.Hydroelectric Power Device
Address(Number and Street)
❑ a 7.Geothermal Energy Heating/Cooling Device
Haubstadt,IN 47639 Gibson ❑ EY 8.Is this property a residential rental property?
G"ry,State ZIP-ode County
❑ 9.Would you like to receive tax statements for this
I 2.Does the buyer have a homestead in Indiana to be property via e-mail? (Provide contact information
vacated for this residence? If yes,provide below.Please see instructions for more information.
complete address of residence being vacated, Not available in all counties.)
including coun
ty
/ Z4Si- Gtd S - , -"
r(Namber and str¢¢t) 26-22-14-300-001. 711-024
li .,.S c/l / t� Jf// IT 1 724) /nc,//Z r)
City.State ZIP Code County property owner contacLaame E-mail
License/ID/Other Number