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I\DU\AS,\LESDISCLOSUREFOR\I SDFID SDOID 1758046 Pag<2
D: PREPARER,.= -. , .. - � ._ _ ., _ . ., ; .-: _-. �._. . , �-. .., -- - - :
KimbeAyA. Lewis Office Manager
PrtyartrofNe Sales OBdosure Form 75tle
26 W. Broadvray Broadway Title, Inc.
Ad1r¢ss/NvmberonCStreeoJ Compony
Princeton, IN 47670-
E.SE�LER(Sl/GILINTOR(Sl��� - . . ` ` . ��`- � .
Shcer 1- Nume as eoyevrs w iom�rjvnre Jocument
27349 CR 37
nee.r.sslNvmar.a�esveeq
Springfield, CO 81073-
L1ry, Statc, andZlPCode
SeOei Z- Name us uppevrs on mrt�qnue Juvmrn[
and Svee�)
Cip: Sm[c, and ZIP lode
Under penaltles oFperjury, l hereby certify that this Sales Disclosure, [o [he 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 Proper[y Sales Disdosure Act".
Co c
-APPLICATION.FOR�PROPERTY T
Signamrm(Seller
qinton A. Rumble �
uyer �Nameasappevrson[om�e}anredacvment Buyer7�A'ameosapprersoncwveyonredocument
9202 Valley Yew Dr.
Add�ess(Nvm6erand5tmt) . Addrar(�\'um6erand50-ee�)
Evansville, IN 47711-
Ciryt Srn(e, and ZIPCOde Ciry, Sm[e ond ZfP Code
�
Teie-honeAUm6er E-ma�l Tele haneNum6er E-mall
TNE S,LLES DISCLOSIIRE FORM MAV BE USED TO APPLY FOP CERTAIIi DEDULTIOVS FOP THIS PROPERTY. IDEhTIFV ALl OF THOSE THAT APPLY.
�� 1. Will this property 6e the buyer's primary �
residence? Provide complete address of primary
residence, including county:
9520 E 450 S
Address (ttumber ond SarrQ
Oakland Ciry, IN 47660 GIBSON
Ciry.SmreZlPCoEe Caunry
�� 2. Does the buyer have a homestead in Indiana ro be
vacated for [his residence? If yes, provide
complete address oFresidence heing vacated,
induding counry:
Addmss (KU m6er and SvreQ
� ❑ 3. Homes[ead
4. Solar F.nergy Heating/Cooling System
� Q S. lNind Power Device
❑ Q 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating/Cooling Device
� Q 8. I5 this property a residential rental property?
❑ Q 9. Would you like co receive [ax statements for [his
prope viae-mail? Providecontoctinformation
e ow. Please see instruc[ions for mo a[ion.
Not available in all counties.)
02� ,l3 _ 35, 300 -000. $87-vo�
Under penaltles of perjury, 1 hereby certify that [his Sales Disdosure, to the best of m}' 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 AcC. (Note:
Spouse i(�(armation, SRci�+Security and Driver's License/Other numbers are no[ necessary if no Homes[ead Deduction is
Pnnrnd Legaf Nome af Buyer I Sign Date (NM/DD/YYI1�
�N
LaslSdigiLCOfBuyerlDriver't 5[ate Las[SDigiaof5ocialSecurityNumber
Gicente/1D/Othe� Number
Signarvre o(Buy�er2/Spouse
➢n'nted Legal ,vame of B yer 2/Spouse
Sign Oate (.NY/DD/YYII]
LastSdigi[so(Buyer7/SpauseDriver's State Las15DigiGSO(Sotial5ecurity
Number Lfcense/lD/OtherNumber