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INDIANA SALES DISCLOSURE FORM SDF ID: P ae 2
CHRISTINA LATHAM TITLE CLERK
Preporeror the SaIssit ovtre Form Tide .
4703 THEATER DRIVE REGIONAL LAND TITLE .
Addres(Number and Saw) Company .
EVANSVILLE. IN 47715 812-4024553 - .CHRISTINA @REGIONAL-LT.COM
aty,Stce and ZIP Code Telephone Number £-mai!
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Rich Smith Monir Smith
Seller 1-Name as appears on conveyance doarmet Seller 24 Nome as appear,an ponveyancidoeuthip
Addres(NNu_mber-andSVea) " - l__ �d2ss(Number ands
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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 operty_ le Disclosure Act".
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Rich Smith Monica Smith �A. • ";\
Printed Name of Seller yc��� Sian Date(NY/DD/YYYY) Aimed Name of Seller Sian Date(MM/DD/!YR)
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Bt. -Name.as. a, .•.conneana docment � -•n on conveyance document
' Street 1007 S Main street
Addres(Number and Street) Address(Number and Street)
Fort Branch. IN.47648 Fort Branch. IN.47648 '
THE S A L E S DISCLOSURE FORK MAY BE USED TO APPLY FOR C E R E A L%DEDUCTIONS FOR THIS PRO•a:•• '• •'• .F nos:r 'T VP IC
YES NO CONDmON NO CONDITION
Fl ❑ 1.Will this property be the buyer's primary � Q ❑ 3.Homestead APR _ 7 2014
residence? Provide complete address of primary —vet I. ar Energy Heating/Cooling System
residence,including county: ❑ ig S.Wind Power Devic
1007 S Main Street
Address(Number and Street) ❑ GI 6.Hydroelectric Pot U AUDITOR
Fort Branch.IN.47648 GIBBON ❑ Q 7.Geothermaal Energy eating/Coo ''rig Device
City,Stitt ZIP Cade Caunry
❑ �i 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 NI 151 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.
nX'
Not available in alll counties.)
Addres(Numb e-and Street) /V `i, s Q7 o(- lb^�• v' /0-Qq6
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a n G.E.Mclrtire
nr•,State LP Code County
Primary property owner contact none E-mail