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INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.PREPARER'e --- - - - - ° - --
CHRISTINA M LENFERS CLOSING AGENT
Hepartro(NeSales Disdasure Form Title
�501 MAIN ST STE 101 BOSSE TITLE CO
— Address(NumberandSReet) Lompany
EVANSVILLE IN 47708 (
Liry, Smle, and ZIPCode Telephone A'umber E-mail
E. SELLER S GRANTOR S- �
DENNIS M DLIVALL DFRRA A_ DUVAI L
Se11eN-Nameasappearsanronveyanredaumenl ' Sel/er2-Nameasappmrsonconveyunreda'ument
74'i4 N MII f FR REED LN 2739 N MILI FR RFED LN
Addres /NUmber and Sveet) dddrm (Number and5tree[J
PRWCETON IN 47670 PRINCETON IN 47670
�ty,5[�qandZ� � �� Ciry.Smh,andZlPIC'adre�
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E-maif
Under alties of perjury, t here?�' certify that Ihis Sales Disclosure, to the bes[ of my knowledge and belief, is [rue, correc[
and co� as required by law, ai� is prep r in accordance with I -1. 5.5, "Real Pro rty Sales Disclosure Act".
� A� , �
5lgnamreo Se er � 5(qnamreo/Selfer
I�FNNIS M Ill NALL O6I75Y2012 DEBRA A DUVALL O6I15I2012
PnntedNameo(Se/ler Si nlMte XM/DD n Pnn[edNamea Seller Si ODa[C XM/DO
F. BUYER S GRANTEE S.-APPLICATION FOR PROPERTY.TAX DEDUCTIONS= IDENTIFY ALL ITEMS THAT:APPLY; ._ -
JEFFREY WAYNE MAYBERRY CHERIE LYNN MAYBERRY
Buyer 1- Nameas appears on [anveyance dorument Boyer 2� Name atappean om m�veydnre davment
3275 QUAIL LN 3275 QUAIL LN
Address (NUmber nnd Svee�) Addrecs (Number and Sveet)
BENTON AR 72079 BENTON AR 72019
E�mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERT.II.Y OEUURIOYS FOR THIS PROPERTY. IDENTIFY A6L OF THOSE THAT APPLY.
YES KO COXDRION I VFS NO CO\DITIOY
❑J � 1. �Nill [his property be the buyer's primary Q ❑ 3. Homestead
residence? Provide comple[e address of primary � a 4. Solar Energy Heating/Cooling System
residej�e, in_clu mg c unty:
a� N I�l�'I�X �Vl ❑ �✓ S. Wind Power Device
,�d'� �N_ p�ra�striq� �6�0 � J�SD� � ❑J 6. Hydroelectric Power Device
w(•'�9 �-3� ❑ ❑✓ 7. Geothermal Energy Healing/Cooling Device
[iry,SmuZIPCOde Counry
� Q 2. Does the buyer have a homestead in Indiana to be � ❑� $• �s fhis property a residential rental property?
vaca[ed for this residence? If yes, provide ❑ ❑✓ 9• Would you like to receive ta�c statements for this
complete address of residence being vacated, property via e-mail? (Provide contact informotion
induding munty: below. Please see instructions%r more information.
Not availa6le in all coundes.J
Address (Number and Svee[)
��.o5.3�aodcb,� ��S' 2a7
Ciry. Smte ZIP Lade lounry .
Pn'marvprnPerryownerronmr[name E�mail
Under penalties of perjury, l hereby certify tha[ this Sales Disclosure, [o the bes[ of my knowledge and belief, is [rue, correct
and comple[e as required by law, and is prepared in accordance with IC 6Q1-5.5, "Real Property Sales Disclosure Act". (No[e:
S e information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
� eing �led.) �
NW�
Sign e/ vyerl Sqnomre o(BUyer2/Spouse
IFFFRFV WAYNF MAYRFRRV O6/15I70�?
Ain ��
LastSdigiaofBuyer2/SpouseDriver's Smte LastSDigiaof5ocialSecuriry
License/ID/OtherNumber Number License/10/OtherNumber
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