Homestead_Workman INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER ._ _ . - .- -- '
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
Ciry,State,and ZIP Code Telephone Number E-mail
._ - . -. - -
E:SELLER(S)/GRANTOR(S) = -_ i. ._ ,.`... . _ -..._.�. .. _ - . . -...-. . .. _
Jeremy Weber
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10901 F 850 S _
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and .mplete as require by la ,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
t,411144aC,t
' no re of Stile Signature of Seller
4/30/2014
Printed Name of Seller Sign DateJMM/00/YYYI) Printed Name of Seller rq 1.• sMM/DD/Ml)
F:BUYERJS�/GRANTEE(S)�='APP,LICATIONFOR'PROPERTYaTAXDEDUCTIONS='IDENTIF.YALL•'IT NIS 1i4AP .1':j%. .`-
(obby G.W_orkmanl)
B err-Aamearappears onconveyance document Buyer 2-Name as appears on conveyance O 7 2014
CI Li \o pack 51t. �IYYII//ll
Address(Number and Street) Address(Number and Street)
-Ennvcx \\ , IN Lrl 1-11C) ✓1i . ;
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
gi ❑ 1.Will this property be the buyer's primary • • 3.Homes --s
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ •
10901E 850 S 5.Wind Power Device
Address(Number and Street) ❑ • 6.Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 0 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 ❑ • 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: .e ow. • . . . . . o r more information.
Not available in all counties.)
Address(Number and Street) /
1` .76. - 17 - aI. .too _ 000. /Ay -0.1-/
City,State ZIP Code County -, ...------E-mail
Primary property owner con tacrslame