HomeMy WebLinkAboutHomestead_Simpson: 1�'DIA�A SALES DISCLOSURE FOR�I
D.PREPARER -
226 W. Broadv(ay
AdJres>(,vumhr oMSVe�rQ
Princetan, IN 47670.
Gty. Sm[e, and ZIP CoEe
SDFID
Kenneth R. Osbome
Srlle�' ]- A'ame us apyevrs on ronve�rmae Jaummt
571 E. Une S�.
Addren (Number and SvretJ
Fotl Branch,IN 4764&
andZlPCode ,�
SDOID 724764
Page 2
O�ce Manager
rme
Broatlway Tltle, Inc.
Compony
Tdephone A'urtrber E-mcll
Seller 2� Nume nt upyears on mmryTm�e do�vment
8112 Lincoln Ave. Apl. B
Addras (A'umberandSVreQ
Evansville. IN 4771 S
Ciry. Slu[e. nnd ]IP Cade �
Under penalties o(perjury, I hereby certify [hat this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and complete�s r�u�d by law, and is prepared in accordance�h IC 6� �.1-5.5, "�al Pro�erty, S�les Disclosure Act".
o,k�,e�
�
Jerry L. Simpson
9u}•er 1� A'ome m oppmrs am m�vewnce Javnen:
4428 S 700 W
Address (h'umber and SverQ
Owensville, IN 47665
�
THE SALES DISCLOSURE FORM MAV BE USED TO APPLY FOR
_ .� .� �,
f�- �s- G6�<<�
DEDUCTIONS-�IDENTIEY ALL ITEMSTHAT APPLY
Q ❑ ]. Wi0 this properry be the buyer's primary �
residence? Provide complete address of primary
residence, induding county:
511 E. VINE ST.
AAdreu (A'umber and Sver�J
Fort Branch, IN 47648 GIBSON
Ci.y.Sru:eZlPCode Caunry
�� 2. Does [he buyer have a homescead in Indiana m be
vacaced for this residence? If yes, provide
mmplete address of residence being vacated,
induding county:
Address (A'wn6er and Svrr:)
Ciry, Sm�e ZlPC�We Caunry
Mita M. Simpson
Buyer? - Name as np➢rors on mme�nnae dotvmrnt
4428 S 700 W
dEdr¢c (Number and Street�
O.vensville, IN 47665-
THIS PROPERTY. IDENTIFS" ALL Of THOSE THAT APPLY.
Q � 3. Homestead
4. o ar •nergy Heating/Cooling System
� Q 5. bVind Power Device
� Q 6. Hydraelec[ric Po�ver Device
� Q 7. Geothermal F,nergy Heating/Cooling Device
� Q 8. Is this property a residential rental property?
� Q 9. 6Vould you like to receive [ax statements for chis
properry via e-mail? (Provide conmct informorion
below. Pleose see instructions%r mare in/'ormation.
hbtavaila6le in all counties.)
o��o-Iq-�8-3b3-tx�l• I� C�d�6
IhimarvomnerNOxmomr.munume t'�mail
Under penalties o(perjury, I hereby certify that this Sales Disdosure, to the best of my knowledge and belie(, is true, correct
and complete as required by law, and is prepared in accordance tvith IC 64.1-5.5, "Real Property Sales Disclosure Ac[". (No[e:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary i(no Homestead Deduction is
being fiied.) �
�, D,G ._.. � „ . �. � _
\/�Nf'% LaJi��i�
Driver's Sm�-
�mher
M1'umbe�
Sign
�
�/