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r.NA SALES DISCLOSURE F01
;EPARER � — ., �
IA C. HARPER
nrer o(Ne Sale Orsdosvre Form
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TOTAL TITLE SERVICES LLC
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EVANSVILLE. IN 47708
E-mail
MARTIN A FREDERICK
Seller]�Nameasappearson mryancedavmm[
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�Addrea(N mberond5vee[)
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Under penalties of perjury, 1 hereby
and comole[e as
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- Name as appears on conveyonce documrn[
Addrm (A'umberandSVeeeJ
Ciry, Srate, andZlP Code
[hat [his Sales Disclosure, [o the best of my knowledge and belief, is true, correct
�pared in accordance wi[h IC 64.1-5.5, "Real Property Sales Disclosure Ac[".
(/ Signamre o(Seller
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vl] Rin[edNameo(Seller
AX�DEDUCTIONS- IDENTIFY ALL ITED15 THAT
Bu�er 2� Name as appears on ronveyanre dorvmen[
Addr� (Number andSVtttJ
Ciry,Smre.
THE SALES DISCLOSURE FORM MAV BE USE� TO APPLY FOR CE0.TAIY DEOIICf IONS FOR THIS P0.0PERT'. IDE�TItV ALL OF THOSE THAT APPL4'.
I,J U 1. Will this property be the buyer's primary
residence? Provide complete address of primary
82I �fesidnep�nnludingtounty:
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2. Does the buyer have a homestead in Indiana [o be
vacated for this residence? If yes, provide
comple[e address of residence being vacated,
induding counq-:
Addrw (NUm6er aMSvee[)
lade
Counry
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3. Homestead
4. Solar Energy Heabng/Cooling System
5. Wind Po�ver Device
6. Hydroelectric Power Device
7. Geothermal Energy Headng/Cooling Device
8. Is this property a residential rental property?
9. Would you like to receive tax statements for this
properry via e-mail? (Provide contact informapon
below. Please see instructions for more in%rmation.
Not available in all counties.J
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name
E-mail
Under penalties of perjury, 1 hereby certify tha[ this Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduc[ion is
�einp filed.) � �
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Signamre of Buyer2/Spouse
PnntedGegalNameO(Buyer2/Spout¢ SlgnDare(MM/o0/YYY1j
LastSdigi6o/'Buyer2/SpouseDriver"s Stn[e LastSDigirsa�5o[ial5ecunty
Num6er Lirense/!D/OtherNumber