HomeMy WebLinkAboutHomestead_Wilson (9)�
Laura Rininqer Cbsing Coordinator
Preparei of the5afes Disclosure Farm Title �
7820 Eaale Crest Blvd Ste 201 Reaional Title Services LLC
�ddres (h'umber md Sveet) Company �
Ciry, Smte, and ZfP Code
Connie Craiq,_(pdiviAuai�y and as Trvstee
Seller I- Name as appmrson ronveyonce docvmen[
Addres' (Number arM Street)
Ft Branch IN 47fi48
City,Srnte,andZlPfnde _ _
Seller 2- Name as appears om m�veyonre document
Addres(Numberard5[reetJ �
1
1
liry, Smte, dnd ZIP fnde
E-mail
Under penal[ies of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is [rue, correc[
and mplete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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Slg�na+deo/Seller ' Sjgnamreo(Seller '
ronveyoncedomment
Addres (Num6erard SGee[)
Ft. Branch. IN 47648
�ry,Sm[e,andZlPlade �
7}IE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR
0✓ � 1. Will this property be the buyer's primary �
residence? Provide complete address of primary
residence, including county:
204 N Elm St
Addres (Number ard Street)
Fl. Branch. IN 47648 Gibson
Clry, Smre ZIP fode Counry
� ✓� 2. Does the buyer have a homes[ead in Indiana ro be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Addrus (Number aM Stree[J
City, 5[ate ZIP Code Lounry
Buyer 2- Name as appevrs om m�veyvnce docvment
Addreu(Num6erand5tree[]
City, Stare, and ZlP Cnde
APPLY.
✓� � 3. Homestead l
'a--Q—�Selac..firterg}rn� g/Cooling System
� Q 5. �Nind Power Device 3 n ��I
� �✓ 6. Hydroelec[ric Power Device I �
❑ Q 7. Geothermal Energy Heating/Cooling Device
� Q 8. Is [his property a residential rental property?
� Q 9. Would you like to receive tax statements for this
property via e-mail? (Provide contoct informo[ron
below. Please see instructions for more informatian.
Not available in all counties)
��o- i�-i3- ���-000_o�g-o�6
mnmtt name
E-mcil
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse informaUOn, Social Security and Drivers License/Other numbers are not necessary if no Homestead Deduction is
being filed� , , ,� � �
o(Buyer7
Pnn[
LaSt 5 digiCS a�Buyer I Driver's State Las[ S Digitt o%Social Se[unry Num6er
License/lD/Other Num6er
Signa[ure o(Buyer2/Spouse
Printed 6egal Nameo(Bq•er1/Spause Sign Dace �abv/D�/��'rY)
Last 5 digiGS o�Buyer7/Spouse Driver'S State Last 5 Digia of Social5ecurity
Num6er Lirense/10/OtherNumber