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INDIANA SALES DISC LOSU REFORM SDF ID: Page 2
-D.- PRE PARER4,-�'�-� �C�,
'4-
Kristin Humeman Closing Agent
PepareroftleSales DLd.,, Form Tide
7820 Eagle Crest Blvd Ste 201 Regional Tide Services, LLC
Address(Nuanbe,tradStreer) company
Evansville, IN 47715
E. SELLER(S)/GR]ANTOR(S) e
John R Gotidard
Seller I -Momeas appears on conveyancedocumear
307 W Gilngon St
Seller 2 - Nome as appears on conveyance document
Address (Number and Street)
HauhqtPrit IN 47639
Address (Number and Street)
E-mail
I Teleehone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as requi . re bylaw, is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature Seller SigrmarreefSeller
John R Goddard 09G0/9011
Printed N ... fSeller Sian Date WXMDIIY PWareciNtane.fSeller Sian Date (M.W/DD/M 11
IF'BUYER(S)/GRANTEE(S)!-'APPLICATION FOR PROPERTY-TAX DEDUCTIONS- IDENTIFY ALUITEMS THAT APPLY,
Joshua J Barnes
Buyer I - Nome as appears on coavnwnm document
Buyer 2 - Name as appears an ma, tymace document
707 W St Anthony
Address (Number and Street)
Address (Number and Street)
Effingham, IL 62401
E-mail
TelcphoneVtanbe, E-mail
THE SALES DISCLOSURE FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
V4 NO CONDITION I ES NO CONDITION
❑ 1. Will this property be the buyer's primary
❑ 3. Homestead
residence? Provide complete address of primary
4. Solar Energy Heating/Cooling System
Xnc�ng county:
re,61;nc
❑ FZ] 5. Wind Power Device
❑ [Z] 6. Hydroelectric Power Device
Oifdre,
HL14(jaw, IV,\ wum
7. Geothermal Energy Heating/Cooling Device
❑ IZI y
8. Is this property a residential rental property?
'06� State ZIP Code I count)-
❑ 0 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not available in all counties.)
Address (Number and Street)
county
City. State ZIP Code
I
Priouny properU• owner contact name E-mail
Under penalties of perjury, I 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 Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being flied.)
l
)9 L. k.
-no ar�l Signature ofliuyer2lSpouse
Joshua J PS 0913012011 Cindy,) Baker 0913012011
PrinteaftegariNtaneefl?,Ttr I Date UWMIDDII�) Printed Legal Name ol'Buyer 2/Spouse Sign Date (X9,VDvM-,J
n
Last 5 digits of Buyer I Driver's State Lost 5 Digits of Social Security Number Lost 5 digits ofillyer2lSimuse Driver's State Lost 5 Digits ofSociol Security
License /ID /Other Number Number License /ID /Other Number