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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER _ - _ _ .. .-. _ -- - -
— - - .. _
LANA C.HARPER CLOSER
Preparer of the Sales Disclosure Form Tide
19 NW 4TH STREET STE 500 _ TOTAL TITLE SERVICES, LLC
Address(Number and Street) Company
EVANSVILLE, IN 47708 812-468-8485
City,State,and ZIP Code Telephone Number Email
CINDY L WFRNZ N/K/A CINDY OG
er1A' as ears on nayancedoc met Seller 2-Name as appears on conveyance document
o , con
dress N be rid Street) ' , 1 (4-7(010 Address(Number and Street)
Telephone Number E-mail Telephone Number E-mail
Under penalties of perjury,1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
).04 complet as re uired by law an is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
( 4 L. 4)1)a r.,,—) L.1
/19B"at`�uIre of jeer\, \,,, Signature of Seller
(. . /.Yti of Nzia �KJ11 � ,.,(Li )." )Ilex)n 0 n "'/L
Printed N ne of Seller &in Date(w.v/DD/Yrrl) Printed Name of Seller Sign Date(MM/DD/InY) •
F.BUYER(S)/GRANTEE(Sy. APPLICATION,F012 PROPERTY TAX' DUCTIONS-,IDENTIFY ALL ITEMS THAT-AP - -•- _ .__
JACK C.ADAMSON JESSIE L.ADAMSON
IBwer 1•Name as ai so tiri any cedcumn, Buyer 2-Name as appears on conveyance document ��
(//]Y(Jssz) 1ICIV\_(jA/�Il/.A](�1LIC ` .
Tress(Number an et) \ ,S�]�/� Address(Number and Street) act?
THE SALES DISCLOSURE FORM MAY RE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.VtiTY
YES NO CONDITION I YES NO CONDITION '9/r„
fl ❑ 1.Will this property be the buyer's primary Fl ❑ 3.Homestead v/TVA.
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
��D �� `resi ,nce.in)•tudi g?aunty: ❑ O r.
-( � { 5.Wind Power Device
mod^/(n�b`,.nndzt�e't� I , \ 4i+ 7 f, �� j 5D(, I ❑ 6.Hydroelectric Power Device
C rt,SState.121PlCaddee� 1 N (1' (J rJ County ❑ 7.Geothermal Energy Heating/Cooling Device
r , "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 ❑ 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.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Cade County
Primary property owner contact name E-mail