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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Tiffany Hoon Closing Coordinator
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Suite 201 Regional Title Services LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 tiffany.hoon(o)regionaltillellc.com
City,State,and ZIP Code Telephone Number E-mail
,E.SECIER(S)%GRANTOR(S)�`- :`+- - :
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Aaron lost
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
30 Box 141
Address(Number and Street) Address(Number and Street)
Hanhctadt IN 47634
Telephone Number 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 . -re'quired b law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Si Se eA000111111r Signature of Seller
Printed Name of Seller Sian Date(MM/DD/YYYY1 Printed Name of Seller Sian Date(MM/DDm711
li ThUYER(SVGRANTEE(S)'g:APPLICATION FORIPROPERT.VAWEDUGTIONSi-d DENTIFYX1LITEMSiTHAIMP.P,Wa
Anthony Vencel Megan Vencel
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
1916 Poplar Dr. 1916 Poplar Dr. -.
Address(Number and Street) Address(Number and Street)
Terre Haute, IN 47803 Terre Haute. IN 47803
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ N 4.Solar Energy Heating/Cooling System
residence,including county: ❑
ig
505 S Lincoln St S.Wind Power Device
Address(Number and Street) ❑ NI 6.Hydroelectric Power Device
Fort Bran h In 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State PCode County
j❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ N 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)
Q (, - 19 - 19 to I nna 9 1„9 0q
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
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Signatur yen Signature ofBuyer2/Spa
Anthony Vencel 04/0080013 Megan Vencel 04/08/2013
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