Homestead_KernINDIANA SALES DISCLOSURE FORM
Preparer of [he Solu Disrlosvre Farm
SDF
Closinq Services
rde
782b Eagle Cresl Blvd Suite 201 Reaional Title Services LLC
Address(Numberand5uee[) fnmpany
Evansville IN 47715
mail
Timot Moeller
Seller 1- Nome as oppevrsom m�veyanre documen[
R045 S Victoria Dr
Address (Numbe r and SlreetJ
Fnrt Rran�h IN 47648
E-mail
2- Name as appeorsom m�veyonce document
Address (Numberand Street)
andZlPCade
Under penalties of perjury, 1 hereby certify that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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S{qnaNreofs � SjgnomreofSeller
Bobby L Kern
Buyer 1- Name os appevrson conveyance document
21 Sunset Ct.
Addms (Number and 5[reet)
Vncennes IN 47591
Buyer 2- Name as appears on conveyance document
507 E MiII Rd
Addres (Number and Street)
Evansville IN 47711
Ciry, Smte, and ZIPCade
THE SALFS DISCLOSURE FOMt AfAY BE USEO TO APPLY FOR CERTAIN DEDURIONS FOR THIS PHOPERTY. IDEMIFl" ALL OF THOSE THAT APPL7'.
✓� � 1. Will this property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
R04F S Vctoria Dr
Addrea (Num6er and Stree[)
ForstBranch IN 47648 Gibson
Ciry. Sm[e ZIP Code Lounry
� ✓Q 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated, .
including county:
Addm.a (Number ord Slreet)
[iry.
founry
�
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❑
❑
❑
❑
❑
❑
✓❑
❑✓
❑.�
❑�
�❑
❑✓
3. Homestead
4. Solar Energy Hea[ing/Cooling System
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating/Cooling Device
8. Is this property a residential ren[al property?
9. Would you like to receive tax s[atemenCS for this
property via e-mail? (Provide conmct information
below. Please see instructions for more information.
Not available in all counties.)
i i � � �� � i �-
name
E-mail
Under penalties of perjury, l hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disdosure Act". (Note:
Spouse information, Social Security and Drive�'s License/O[her numbers are not necessary if no Homestead Deducdon is
being filed.) ,
� � =�— n��. a.- �
5(gnature o(Buyerl 5(qnature o(Buyer2/Spouse
Bo6by 1 KPrn 09-20.2012 Laura A Batta 09-20-2012
PrintedGegalNartreo/Buyer] SignDate(MM/�0/YYYh PrinredLegalA'ameofBoyer2/Spouse SgnDate(MM/0o/YYYp
Las[ 5 digits of Buyer 1 Dnver'S Smte Last 5 DigiU o(Social Security Number Las[ 5 digiGS o%Buyer 2/Spouse Driver's Smte Las[ 5 DigiCt oJSotial Security
License/ID/OtherNum6er Num6er Lirense/ID/OtherNumber