Homestead_Miller (8)SHANNON LIBBERT
LPreparer of fhe Sala Disdosure Form
Addras (Number and Sveet)
Title
REGIONAL LAND TITLE
Company
EVANSVILLE IN 47715
mail
LARRY AI VIN DOFRNFR
Seller 1- A'ame as oppmrs om m�veymce dxumen[
9/aq �,ur.1����D �,�
Address (h'umber and Sveet)
�uf�nl.; Ui.L� � Zti/�, y/�%//
Ciry, Smrg ond LP Lode
'`�5�
LINDA SUSAN DOERNFR
Seller2 - Name as appevrs on convevance dxument
9� � 9 0����,,.� nr�
Addras(Numberond5tret[)
,Eva,�sdi//•z 2� �/77//
Ciry.Srate, andZlPCode
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Under penalties of perjury, I hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, correct
and complete as require/�d by law, and is prepared in accordance with IC 6-1.1•S.S, "Real Property Sales Disclosure Ac[".
U T2..r�1. r1� .irb�.� S c�oi+-.L ,t�R°.r�+-k-
namre � Seller - Sgnamreo(Seller
LARRY A VIN DOERNER 3'��" �� I LINDA SUSAN DOERNER 3 �/"I /
Sneey
.ry,5mce,andLPy� e u//?Cl
_ . ( � _ . �
THH SALFS DISCLOSURE FORM MA}' BE USED TO APPLY FOR CERTAIK
Q � 1. Will this proper[y be the buyer's primary
residence? Provide complete address of F
residence, including counry:
1?04 TOP HAT ROAD
Addras (Number an d Sveel)
PRINCETON IN 47670
City, SmteZ/PCode CounN
� �2. Does the buyer have a homestead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county: .
Addras (A'umberand SveetJ
Ciry, Smte7JPCode CounN
Bwrl2 - Name
Addras (A'umber md SveetJ
PRINCETON IN 47670
`�" ��` N/��
IDE\TIFI' ALL Oi THOSE TlF4T APPLY.
Q✓ ❑ 3. Homestead
Hea[ing/Cooling System
S. Wind Power Device
6. Hydroeledric Power Device
❑ ❑✓ 7. Geo[hermal Energy Hea[ing/Cooling Device
� Q 8. Is this property a residential rental property?
� 0✓ 9. Would you like io receive [a�c statemen[s for this
property via e-mail? (Provide conmct in(ormadon
below. Please see instructions for more informadon.
Not availa6le in all rounties.)
JA� MI� IG`o3�U o�o• �47- oa ?�
Aimarvurover[vaumerconmaname E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared i� accordance with IC 64.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other ry�nbers are not necessary if no Homestead Deduction is
o/enyen
Pnnted
L icense/(D/Other A'umber
Number License/lD/OtherVumber