Homestead_Maddox / F•
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Laura Rininger Closing Coordinator
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd.Ste 201 Regional Title Services. LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555
City,State,and ZIP Code Telephone Number E-mail
E..SELLER S GRANTOR S 1 - - - — -. _ .. .
Estate of Rita K Wilson
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2125 1st AvP
Address(Number and Street) Address(Number and Street)
J-laubstadt. IN 47639
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 as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
rev\.._ lh 3(11
Signature of Seller Signature of Seller
Mn M Gerteisen Personal Representative 3/7/2014
Printed Name of Seller Sian Date(hot/DO/Y ell Printed Name of Seller Sian Date IMWDDIYIYYI
_F..BU,YER(S)'/GRANTEE(S);-APPLICATION IFORIPROPERTY,TAX•DED.UCT10NS- IDENTIFY,ALLJTEMS\THATAPPLY__ ____
Ken B. Maddox
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
101 N.McCreary St.
Address(Number and Street) Address(Number and Street)
Ft.Branch. IN 47648
THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION /F D
Q ❑ 1.Will this property be the buyer's primary ❑ 3.Homomestea
residence? Provide complete address of primary ❑ Q 4.Solar Ener He "no poling System
residence,including county: ❑ 0 5.Wind Power Devic
212 S First Ave 1 1 2014
Address(Number and Street) ❑ 0 6.Hydroelectric P e' D€vice
Haubstadt, IN 47639 Gibson ❑ 0 7.Geothermal Ener.• Heati /G.• ' • Ievice
City,State ZIP Code County O
❑ Q 8. Is this property -, . ^''1r 't ar rty?
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 9.Would yoG( �tnIINTY A
vacated for this residence? If yes,provide ax 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)
096-1C1 -31-3b4 - bet ?S-pct
CID'.State ZIP Code County
Primary property owner contact name E-mail