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. INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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D,PREPARER _�. `
LANA C.HARPER CLOSER
Preparer of the Sales Disclosure Form Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES,LLC
Address(Number and Street) Company
EVANSVILLE,IN 47708 812-468-8485 ____ _
City,State,and ZIP Code Telephone Number E-mail
,E:SELL•HR(S)/GRANTOR(S)t . '4.$',`-:- r7-7 - =-:- f- -- r, .C.— ^ 'c,. :=.i s ,
FIIGFNF RAY VANWAY DANAF-VANWAY
Seller 1-Name as appears on conveyance document, Seller 2-Name as appears on conveyance document
c12(0 712 ,'1li:) ST
Address(Number and Street) Address(Number and Street)
/
/OF -"I..- 1 _ / s' J
Telephone Number - E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn. - e as required b law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
J.4 - -
ignatu eler ' ' I 2) j Signature of Seller
Printed Nrfil of Seller Siq ats(MM/DO/YYY1) 1 Printed Name of Seller Sian Date(MA
<F.BUYER(S)/GRANTEE(S):-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY-ALL ITEMS THAT APPLY: _ . 77.7. _ T._ _ .
CATHY C.MARTIN
.Name as appears conveyance docym Buyer 2-Name as appears on conveyance document
A... ess(•u er and Stree Malin S
Address(Number and Street)
ILL'Li Al 7666
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE TIIAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 5 4.Solar Energy Heating/Cooling System
ooto esi a ce,includi co nty: ❑ 0 5.Wind Power Device
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Ci{address(Nontirt and treetLI '� (47 L66 6 /`I c5 o J ❑ 0 6.Geothermal Hydroelectric mal Energy Power Device
Il.tPC IJl(`l l^ - ❑ 0 7.Geothermal Energy Heating/Cooling Device
Ci ,State ZIP Code County
❑ 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 ❑ 0 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.
S S
Ct O Rd 4S ,
o Not available in all counties.)
C(��dr'est(NumberyyndStreet) 1 /f LL�� �j " ����
WIn `0( A) 1iN 4 l Tle a,tp-I -1 ICJ a (ig I a u 'l c
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 D ' er's License/Other numbers are not necessary if no Homestead Deduction is
being fiJep,) I
CHQ ,.
re fBUyerl / Signature ofBuyer2/Spouse
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Number License/ID/Other Number