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CHRISTINA LATHAM TITLE CLERK
Preparuo(the5a/a Disclosure Form Tirle
4703 THEATER DRIVE REGIONAL AND
Addres(NUmberond5veetJ Campany
EVANSVILLEIN 47715 NA
Gry, State, and ZIPCade Telephone Numbe� E-muil
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.Seller ]- Name as ao0�rs on convryonre datvment � �/
KIMRFRI Y C'Of 1 INC
Seller 2- Name as appevrs an conveyanredocument
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Addr�' (A'umber and SbeerJ
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Ciry, Sm[e, and ZIPCade I�
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Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co 1�� requi�ae�, and is prepared in accordance with C 6-1.1•5.5, "Real roperty Sales Disclosure Ac[".
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Bwer 2- Name as appears an canveyance documenr
Addras(NumberandSRee[)
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THE S1LES DISCLOSURE FORM AIAY BE USED TO APPLY FOR CERTAIN DEDUCfI0N5 FOR THIS PROPERTY. IDENTIFi" ALL OF THOSE THAT APPLY.
�� 1. Will this property be the buyer's primary \
residence? Provide comple[e address of primary
residence, including county:
`�12� � �c'�'2r'�i.�r-C QC.
1Addras(Nvmberand5treet) T ��,
Gry, Smre ZIP Counry
� 2. Does the buyer have a homes[ead in Indiana to be
vacated for [his residence? If yes, provide
complete address of residence being vacated,
induding county:
(NUmberand5tree.)
Ciq•, SmreZIPCode
Lounry
� 3. Homestead
4. Solar Energy Heatin�/Cooling SysTem
�X S. Wind Power Device
� � 6. Hydroelectric Power Device
� � 7. Geo[hermal Energy Hea[ing/Cooling Device
� � 8. Is Chis property a residential rental property?
� �9. Would you like to receive tax statemen[s for this
property via e-mail? (Provide conmct in%rmatlon
6elow. Please see instructions for more information.
Not available in all counties.)
a!o-os-3a -/oa - ov.t. /�/ -��7
LANCEJBARNEY
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Under penalties of perjury, l hereby certify tha[ 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 informa[ion, Social Security and Driver's License/Other numbers are noc necessary if no Homestead Deduc[ion is
b�g filed.)
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S(qnawreafBUyer7 5{qna[ureofBUyer2/Spouse
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Llcense/ID/Other Num6er
Pnn:edLegolNameafBvyer2/Spause 5(qnDote(MM/DD/YYYYJ
LastSdigiaofBuyer2/SpouseDriver's Stnte LastSDigi6of5ocialSecunty
Number License/ID/OtherNum6er