HomeMy WebLinkAboutHomestead_Smith (20)INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Creyarera(lhe Sales Disclasure Form
279 N. Hart St.. PO Box 13
lrpss (Number a�d Street)
,ceton.IN 47670
Cip•, Smre, and ZIP Cade
E.
C]MH HnmPC Inc
Seller 1� Name as oppears on ronveyanre do�vment
5000 ClaWon Road
Addrecr (Num6er ond StreeQ
Marvville TN 37802
Ciry. Smte, and ZIP Code
-
E-marl
Title
Hall. Partenheimer & Kinkle
Compony
E-mail
Sellerd � Nameasappeorson wnve}nnce dommmt
Address (Num ber o�d 5[reeQ
Ciry, Smte, and Z/P lode
Number
Under penal[ies of perjury, 1 hereby cerdfy that this Sales Disclosure, to the best of my knowledge and belief, is [rue, correc[
and complete as requir�ed by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
�� ��_�C,��
� noNreo/Selle� SignaNreo(Seller
F. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX [
Teresa R Smith
8+rve� 1- Name os appears on conve}mce dorvmen[
Addres (Number and 5[reetJ
Buyer 2- Name as oppears on ronveyonce document
Address (Number and 5[reetJ
Ciry. Smte, md ZIP Code
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCfI0N5 FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TNAT APPLY.
�✓ � 1. Will this property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
104 E FoctPr SirPet
Addres (Number a rd 5[rret)
Fort Branch.IN 47648 Gibson
Ciry. Smte ZIP lode Counry
Q✓ � 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding counry:
1587 W 400 S.
Addres (Number and Stree[J
Washinqton IN 47501 Davies
liry, SmteZlPCode County
Q Q 4. Solar Energy Heating/Cooling System
� � S. Wind Power Devi�e
� Q 6. HydroelecMc Power Device
❑ ./❑ 7. Geothermal Energy Hea[ing/Cooling Device
� ✓Q 8. Is this property a residentlal rentai property?
� Q 9. Would you like to receive tax statements for this
property via e-mail? (Provide contoct information
6elow. Please see instructions for more informatian.
Not available in all counties.)
a�- ��-a�—ao�-ooi..�
Teresa R. Smith �Uo�j
name
E-mail
Under penalties of perjury, l hereby certfy that this Sales Disclosure, to [he best of my knowledge and belief, is tne, correct
and comple[e as required by law, and is prepared in accordance wi[h IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse informadon, Social Security and Drivers License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
�
ture o(Buyerl Signature ajBuyer2/Spouse
TPraco R Sm'th OAI04I2011 __
Pnn[edLegalNameojBuyerl 57gnDate(
Num6er Lps[ 5 digi6 af Buyer 2/Spouse Dnver's Sm[e Last 5 DigiCS o�5ocialSeturiry
License/ID/OtherNum6er Num6er Lirense/lD/O[herNum6er