Homestead_Wallace (14)' I�DIA\q S:1LLS DISCLOSURE FOR�i SUF ID 26-2009-1000521
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226 W. BROADWAV BROADWAY TITLE, INC.
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PRINCETON, IN 47670 (
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B TODD MOSBY
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2208 LAKE ROAD
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PRINCETON. IN 47670
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(812)000-0000
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Jnder penalties of perjnr��, I herebc certifi� tha� this Sales Uisclosure, [o the best of mc knowledge and belief, is true, correct and
�omplete as required bp Ia«�, and is prepared in accordance �ci�h IC 6-I.LS.�. "Real Property Sales Disclosure AcY'.
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WILLIAM R WALLACE III
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EVANSVILLE, W 47714
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APPLI'FOR
r 1. R'iil this property be the buyer s primary residence'.' Provide com�r�e
address of primary rcsidcncc. including counry: ��
2208 LAKE ROAD
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PRINCEfON, IN 47670 Gibson
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r?. Dozs the buper have a homestead m be vacated for thi� msidence? I!
yes, provide complete addms� of re>idenee vacatine, includine county:
DUCTIO\SFOH"I
r, 3. Homw[ead
r 4 Solar�rx¢�Hcatin_�CoolineS}stem
r� 5_ q�ind Pea•er Drvice
r 6. flqdroclecuic Power Device
r. 7. Geoehennal Energy Ilea�ing/Cooling Dcvicc
r 3. Is [hi� property a residen[ial renufl property?
r 9. ��'uuld you like ro recieve tax sea[emenn for this propem• ��ia
e-mail? (NO�+de ronmcr infarmatian belmv. Please see ihe
insrrnoriortr far more injormarion. �\'or mnilabla In aA rounries.)
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Under penalties o per�ury. 1 hereby cernh• that this Sales Disclosure, tu t e est uf mc kno��led�e and belie(, is true, rnrrect and complete as
reyuired bv la�r, and is prepared in accordance ���ith IC 6-1.1-5,5, "Real Properry� Sales Disclomre Act". (\ote: Spouse In(ormation, Social Securih�
and Dri�e�'s Lic�duth9r nu�bers are not necessarr i( no Homes[ead Deduction is bein� filed.)
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