Homestead_RobertsonFORM SDFID:
S C LibbeR Mananger
Neparer o(Ne Sales Disdosure Form 75de
�03 Theater Drive Reqional Land Title
rddras(NumberandSVeet) Campony
Evansville IN 47715
E-mai/
7v
Seller 2- Name as appmrs on convnnnce docvment
Addrm (Number ond SoeefJ
Ciry, Srurg and ZIPCade
Uuder penal[ies of perjury, t hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and omplete as required by law, and is prepared in accordance wi[h IC 6-1.1-S.S, "Real Property Sales Disclosure Act".
��� ���
s�naaveof5e1n1 / I Sgnoareof5eller
L n �; ' Yn.,., m. �n /�9/„70 /(�
Buyrl ]- Name ot appmrs an
I�
MAY BE USED TO APPLY FOR CERTAIN DEOUCf10N5
Q � 1. Will this proper[y be the buyer's primary �
residence? Provide complete address of prima
r sidence,' cludingcounry:
�pdress(A'um an Svee[) �� } �� O`^
J , , ��
�Ciry,Sm�IP ode � lounry
� 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 (NUmber and Stree[J
Lity, Srare LPCode
Counry
evyer 2- Name as oppevrs om m�veyance docvmrnt
Addrgs (Number and Stree[J
Ciry, SmtG and Z1PCade
THATAPPLY.
Q � 3. Homestead
En ating/Cooling Sys[em
❑ J 5. Wind Power Device
� Q✓ 6. Hydroelectric Power Device
❑ Q 7. Geo[hermal Energy Heating/Cooling Device
� �✓ 8. Is this property a residenrial rental property?
� Q 9. Would you like to receive [ax sta[ements for this
property via e-mail? (Provide contact informadon
below. Please see instructions for more informadon.
Nat available in aIl coundes.) � �
a�-/a.-i�-,sos�. aoa. 096�;�
da /)L
ownermnratt name
Under penalties of perjury, I hereby certify [ha[ this Sales Disclosure, to the best of my knowledge and belief, is true, correct
aod complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ad". (Note:
Spouse iuformation, Social Security and Drivers License/Other numbers are not necessary if no Homestead Deduction is
beingfiled.] _ ,
PRnred Legal Name o(Buyer 1 5(gn Da[e (NH/no/rrvp
LattSdigi[so�Buyer]Driver"s Smte LastSDigiGSO�Social5ecuriryNumber
L irense//D/Other Num6er
Sqn v�re of Buyer2/Spo¢se
Pnnced Legal Name o/Buyer 2/Spouse
S(tJ� Date (MH/OD/YYYY)
LostSdigiGSO%Buyer2/SpouseDriver"s Sta[e LastSDigitsofSocialSecurity
Num6er License/lD/OtherNumber