Homestead_Partenheimer (4) ■ 1
INDIANA SALES DISCLOSURE FORM SOF ID: Page 2
ID'PREPARERA'. - -. - __ —,'a ..• t.-`e. e`T' _ -.r.. - �y-9- a•
CHRISTINA LENFERS CLOSING AGENT
Prrparer of the Salm(Manure Form MN.
501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 18121421-4000
City.State.and ZIP Code Telephone Number Small
iE.'SELLER(S)/6RANTOR(S)I'— .7777-1/.... 7:77F-2=7,. :. '...;t....-_ 102e:777`T_.__... _...-. _.. ._ 9
tae.: • .1 L LIE ;s. •a •••• LI
Seller I-Name at appears on conveyance do vment Sala 2-Nameat appean on conveyance document
40 MARIFTTA ST
Addrxr(Number and Street) Address(Number and Street)
ATLANTA GA 3(1303 _.
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct
agdin ipl ee at—s required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/
7�����kSignature- Sel Signature of Setter
77777k I w-P o71rsjaaY
1 IThted Name7seller Ann Da INN/DD/Yrn1 Pnnt.• Sion Date lNUNaR1111
IF?0 °APPLICATION•FOR PROPERTY,TAX DE/.' THINS_`iDENTIEY'ALL'I - STHATIAPPLW:i-: .�.- -d
•• . -. _ r _i .1 . _ •_. .. II
Buyrr I'Name as appears on taavymrrr••• t - --- veymxe Conmrnt
• NI•AILa.rl;•ennrmCea•7l■ 0-4 ....,...—•
Address(Homier and Street) Addrer(Number and Stmt)
MAINEVILLE OH 45039
TIIE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PRO'a: • 1e--- • THOSE THAlp9�.��� p a
YES NO CONDITION / YES NO CONDITION pBA�TI Beg ■eYYs
J" ❑ 1.Will this property be the buyer's primary ` Y ❑ 3.Homestead
residence? Provide complete address of primary • r- -•- • ar nergy Heating/C g
resid n e,I lud county: JCL -li �14
/),36+ s - ❑ L1' 5.Wind Power Device •
/AI(- deps(N(a'm/x{rp-qn�dSvt�re�ett) I '.i/ 7O ❑ [., 6.Hydroelectric Power De 'ce
ity,Snre DP me T t0 County ❑ 7.Geothermal Energy He Ice
❑ �Z.Does the buyer have a homestead in Indiana to be ❑ i 8.Is this propertygl$$dithtiliadatiT�r4WileOR
vacated for this residence? If yes,provide ❑ a 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.
Not available in all counties)
Addnm(Number and Street) of -/a-o 2 Jas-0007. off" Oa8
City,State 21PCode County
Primary property inner contort name Small