Homestead_Smith (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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
City,State,and ZIP Code Telephone Number E-mall
(E:SELLER(S)/GRANTOR'S): — __ _ _
Channon Rnhh
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
108 S Church St T(7 5ox nZ�
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,I ereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
dnd\c mplete as re q a ip law,and is prepare in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
k�� �t- 2) –ICI
,ure of Seller Signature of Seller
Channon Rohh 110412014
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller Si re('11/
;F:BUYER(S)%GRANTEEM ,AP,P,L'IGATION•EORIPROPERT,YCTAXi.I)EDUGTIONS IDENTIFY-'ALI.ITEM _ A - P - r
Justin L,Smith Tosha R,Smith DEC 1 ,(
2014
Buyer l'Name as appears on conveyance document Buyer 2.Name as appears on conveyance document
5939 S 1050 W 5939 S 1050 W
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665 Owensville, IN 47665
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I NO CONDITION
Q ❑ 1.Will this property be the buyer's primary ig ❑ 3.Homestead
residence? Provide complete address of primary a , oar Energy Heating/Cooling System
residence,including county: ❑ ig S.Wind Power Device
304 S Mill St
Address7Numberandstreet) =E=®=6::Hydroelectric-PowecDevice_ _
Owensville, IN 47665 Gibson ❑ GI 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ fl 2.Does the buyer have a homestead in Indiana to be El 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ TA 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)
02(0-17-)a ao3- 00o. 0o.9 a." -
City,State ZIP Code County E-mail
Primary property owner contact name