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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER `- - -•
Sherri S Hudson Closing Manager
Preparer of the Sales Disclosure Form Title
501 Main Street, Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(5)/GRANTOR(S). .- `- . _ r. . . — - ' _._
' "
_Keith A.Murray Cindi E Murray
Seller l-Name as appears on conveyance document Seller 2-Name as app n conveyance d ument �s
/60g � 67-43-r-. !f9?5 brneeA, L teat/
Address(Number and Street A s(Number and Street)
�n/ l 41842- atA
Under t enalties of perjury,I hereby certify that this Sales Disclosure,to the best of my kno ledge and belief,is true,correct
and c• plate as e! ired by law,and is prepared in accordance with -1.1- .5," ape Sales Disclosure Act",
/ 11f`/
'ignature of Seller F3¢ e Signature of Seller
Keith A Murray —8-13 Cindi E Murray IS
Printed Name at Seller Sian Date DIM/OD/TIYY) Printed Name ofSeller Sian Date WM.M/DO/y1Yn
F.B /GRANTE "- TAX) I NTIFYALL ITEMS THAT APP.IiY_ .77,...--.±."1 - _
Brian R. Stout Melinda J.Stout
Buyer I-Name as appears•• •nveyance document Buyer 2-Name as appea conveyance document
•• •.
ace -
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 Haubstadt, IN 47639
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 'n N
all ❑ 1.Will this property be the buyer's primary / Cin ❑ 3.Homestea.'
residence? Provide complete address of primary ❑ 19 oar Energy Heating/Cooling System
residence,including county: ❑
5.Wind Power Device
208 N.Race St
Address(Number and Street) ❑ ig 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑ 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 ❑ P4 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.
/
•20 12 A 1-pK- SA
Not available in all counties.)
N Street) _1ti•vbAd+ _70V `71`3q G,75...i dOrg3 J -t3W- /VO' 2,..1-&--
oaV'
City.State ZIP Code County
Primary propertyowner-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
be filed J
Signature of Buyerl Signature ofBuyer2/Spouse /
Brian R Stout O/8/3 Melinda I Stout {//l 3.