Homestead_CouchINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D..PREPARER• .r - r , _ . : .. .. .,.,. , , _ _
Y, _ ;,. . .. .,. ,,. ;.. ° • . . . ,
Miche]e Havnes Closina Aaent
�Preparer o(Ne Sala Disdosure Form Title
501 Main Street. Sie 101 Bosse Title Comoanv
Addres (NUmber andSVeeQ Company
Evansville IN 47708
liry, Smte, and ZIPCode Telephone Number E-mail
. ..... . .� ._ . .. _ . . '_ ' ' . '
ECSECLER S � GRANTOR S :: ���- �'- � _-_...._. .... -. - � � - _�- �- - . ."'- - `'.. . -_. . � - .
Isaac S Rimh Sandra L Birr.h
Seller ]� Name os appears on ronveyanre document Seller 2- Name as appears an ronveyonce dxumenl
903 F Walnut Street 903 E Walnut S[reet
Addrm (Num6er and StreelJ Address (Nvmberond Sntt[)
Fnrt Rranch IN 4764A FnciBranch IN 47648
Ciry. Smte, and ZIPCade Ciry. Srntq and ZIP Cade
E-mail
Under penalties of per'ury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
anQ comple e a re u' ed by law, and is prepared in accordance wi[h IC 6-1. � S.S, "Re� rope� isclosure Ac[".
Il j � f
�A✓�4i c4 XXt-tit(;tnr�
�g�5e1/er Signamre o(Seller
Icaac S Biroh 04l13I7011 Sandre L Birch 04/13I2012
PnntedNamea(Seller SionDaa MMOD PnnadNameof5elfer Si nDareGtM/00/1
P: -' EE 5-`APPLICATION FOR PROPERTY-TAX DEDUCTIONS- IDENTIFY ALCITEMS.THAT APPLY . ��
EI ine Cou h
Bvye�l-Nameasa nconveyanredarumeu Bv}xr2�Nameasappearsonconveyanredoavmm[
N/4%5$
Addr� (NUmber and5veet) Addres (Num6er andSVeeQ
Owensville IN 47665
�ry. 5[au, and Z(P Lode Ciry, Smtt and ZIP Cade
E-mall Tele haneA'umber E-mail
THE SALES 015[LOSURE FORM MAY BE USED TO APPLY i0H CERTAIN DEDURIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TI1AT APPLV.
YES NO CO�DITION NO COADITI .
�J � 1. Will this property be the buyer's primary J❑ ❑ 3. Homestead
residence? Provide complete address of prim ry , � ea[ing/Cooling Sysrem
residence, including county:
903 E Walnut Street ❑ Q✓ S. Wind Po�ver Device
Add�ess(NUmberandSveeQ ❑ ❑./ 6. Hydroelec[ric Power Device
Fort Branch. IN 47698 Gibson � Q 7. Geoihermal Energy Heating/Cooling Device
Ciry, Smu ZIPCode Counry
Q � 2. Does the buyer have a homes[ead in Indiana [o be � ❑� 8. Is [his property a residential ren[al property?
vaca[ed for this residence? If yes, provide ❑ ❑✓ 9. Would you like to receive ta�c statements for [his
complete address of residence being vacated, property via e-mail? (Provide contoct injormation
including county: 6elow. Please see instructions for more in(ormation.
6385 W 475 S Not available in all counties.)
Addrrss (h'umber andSVee[J �/
Owensville.IN47665 Gibson �p..����.�p�000, %T�'OaG
Ciry, Sm[e ZIP lade Covnry
Pnmary p�aperry owner ronmt[ name E�mail
Under penal[ies of perjury, 1 hereby certify [hat this Sales Disdosure, to the bes[ 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 Proper[y Sales Disclosure Act". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
being filed.)
SignaNreojBv}•� � Signamreo(Buyer2/Spouse
LastSdigiao�Buyer]Oriver's 5[ate LastSDigi[sojSocial5� last5digi[sa�Buyer2/SpouseDriver"s Stare LuslSDigiti'of5acia15ecuriry
License/ID/OfherA'umber Number License/1D/OtherNum6er