Homestead_Emerson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
?-D6P.REPARER— . - - -_
Laura Rininger Closing Coordinator
Preparer of the Sales Disclosure Form Tide
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-mall
'E:SELLER(S)/GRANTOR(S)I t. - - _ r--r _ -
Scott A Goodman Valeisha L Goodman
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6010 S Main St 6010 S Main St
Address(Number and Street) Address(Number and Street)
Vincennes IN 47591 Vincennes IN 47591
Under penalties of pe/pjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as equired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
dzeie %, t ,wJ1N�- h tt\ccutv\o.tr
• Signature of Seller - Signature of Seller
Scott A Goodman 11/240014 Valeisha L Goodman 11/4/2014
Printed Name of Seller Sian Date(MM/DD/MT) Printed Name of Seller Sian Date(MM/DD/YYYY)
iF.:BU,YER(S)%GRANTEE(S)cAPP.LICATION-FORTPROPERT,Y:TAXCDEDUGTIONSE.IDENTIF.Y,ALL.ITEMStTHATrAPPLY'- -r. - _ -.
a
Joseph S. Emerson 1
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document . rr
/ /
420 E. Broadway r-
Address(Number and Street) Address(Number and Street) j
-Princeton, IN 47670 Ov + I
THE SALES DISCLOSURE FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APP' ,.
YES NO CONDITION YES NO CONDITION N?),
19 ❑ 1.Will this property be the buyer's primary Fl ❑ 3.Homestead HGO/T
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System°?
residence,including county: ❑ 0 5.Wind Power Device
2426 E Dead I ine Rd
— —Address(Npmberendstreet) _❑=0_6.Hydroelectric Power Device
Hazelton, IN 47640 'VendeibaPgTI -
City,State ZIP Code County ❑ 7.Geothermal Energy Heating/Cooling Device
T (I 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 ❑ 0 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.
420 E.Broadway Not available in all counties.) ,S
Address(Number and Street) 6°1— /f0 °ad 0172—o/ /
Princeton, IN 47670 Gibson �1-.
City,State ZIP Code County
Primary property owner contact name E-mail