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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER •
Jeff H. Bosse General Manager
Preparer of the Sales Disclosure Form Tide
501 Main St.,Ste. 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708
E-mail
nELLER(S)/GRANTOR(S)7;;L.'P.,:f:_t"atV717r;-2.,:- Htrk 7!-Efft4P7e17:44`::-7:::tr-t-Cff1=1:
Karen L Clevenger nka Karen Williams
Seller'-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
303 E Poplar St
Address(Number and Street) Address(Number and Street)
Fort Branch IN 47648
City,State,and ZIP Code City,State,and ZIP Code
E-mail Telephone 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 required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
1/141A144-X CiliVer- 444 thattaint4)
Signature of Seller
JAN 2 5 2013 Signature of Seller
Karen Williams
Printed Name of Seller Sian Date NM/DWITYY)
Printed Name of Seller Sign Date(MMOWYM)
EBUYER S ..GRANTEE(SM'APPLICATIONiFOR.PROPERMTAX DEDUCTIONS;IDENTIFIALe ITEMSTHAT APPLYZ:.
Maurice R.Williams Karen Williams
Bu er I-Name as appears on ,• cc document Buyer 2-Name as appears on conveyance document
N.
303 E.Poplar St. 303 E.Poplar St.
Address(Number and Street) Address(Number and Street)
Fort Branch,IN 47648 Fort Branch, IN 47648
City.State,
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES . NO CONDITION -v-Fkg—len- CO DITION
B fl 1.Will this property be the buyer's primary p 3.Homestea
residence? Provide complete address of primary ----ErE 4.Solar Energy Heating/Cooling System
residence,including cnty:
3 3 k P490 Q.r •S 5.Wind Power Device
_Adress(Number and Street) p "g 6.Hydroelectric Power Device
4-', c.a fan 6 iks o,f1. p u 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
p 2.Does the buyer have a homestead in Indiana to be 8.Is this property a residential rental property?
vacated for this residence? If yes,provide S c 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)
2er 19-7C9 /0/- 000, 7 y -, -D
City,State ZIP Code County
Primary property 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 fi e .)
141,An. CaAnta/M41-)
2 5 2013
Signature of Buyer! Signature of Buyer2/Spouse
Maurice R Williams AN 2 5 2013 Kgrer, JAN