Homestead_Reising (5)J
REFORM
Preparer o(the Salu Disclos�re Form
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SDFID: 1 ` I1�
Manager
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Direct Tiile Insurance Agencv. Inc
Compony
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Evansville IN 47715 812-2533090 ddoweil(a�directtitleinc.com
Ciry, Smte, and ZIPCode Telephone A'vm6er E'-mail
E. SELLER S GRANTOR 5 ^*, "y r � _'> '. :'y -= 9 u. r Y - • ,.��, . : ., .. - , : ,�
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Seller]-Nomeasappearsomm�rn'ancedxvme Seller2-Nameasappeorson�onveyoncedo[vm �
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�ress (NUmber ond5ntt[J �drus (Nom6er ond Sh'ee[)
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Under penal[ies of perjury,l hereby certi(y tha[ [his Sales Disdosure, [o [he bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in acwrdance wi[h IC 6-1.1•5.5, "Real Property ale Disdosure Ad".
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�5 na[ureo Selfer Si na[ureo Seller , , /
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1- Namt as app�pn am m�veyonre
By�er 2- h'ame as appears on �anvtyanre doavmen[
Addr¢s(Num6erandS�eeQ
Ciry, Srntt. and ZIPCode
APP.LY�-.:;•�. ;".c..�-`
APPLY i0R CERTAIY OEDUCTION$ FOk THIS PROPERTY. IOENTIFY ALL OF TNOSE THAT APPLY.
�❑ I. Will this property be the buyer's primary
residence? Provide comple[e address of primary
re dence, indudi� county:
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T�..(,1'urv�r.�r.d5[ree[) , � �����
.;�4 Si�i1��A%l
Ciry. Smce ZIP Code Covnry
� �2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (Number and Stree[J
Ciry, Smte ZIP Code Counry
�" ❑. 3. Homestead
Heating/Cooling System
� �5. Wind Power Device
❑ ��6. Hydroelectric Power Device
❑ �/ 7. Geothermal Energy Heatlng/Cooling Device
� � 8. Is [his property a residential rental property?
� �9. Would you like to receive [ax statements for this
property via e-mail? (Provide contact inform6non
. below.Pleaseseeinstructiansformoreinformation.
,� Not availa6le in all counties.) �
c��Z� � . `i�21�S 111 �
Primarv nmoem owner canmtt name E-mail
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