Homestead_Marceaux INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
_D PREPAIER _' v '- - -_" IT 'TT': —r:
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE. IN 47715 812-402-4553 _ CHRISTINA @REGIONAL-LT.COM
Ciry,State,and ZIP Code Telephone Number E-mail
;E:.SELLER/S GRi1NTOR(s)C .. ,7.4-. ,+c I... -'11, 1—__ i 4 - - ` .',
Kenneth C Goldbach Robin A Goldbarh
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
lit-go 5 old P2-Aerchtlrs ed • `-i/Ll (, e, or f) Pei-t •;tu<<- ,E.0
ddress(Number and Street) Address(Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as require by w,and is prepared in accordance with l&6-1.1-5.5,"Real Property Sales Disclosure Act".
C44.� ;f%l /� /&
S(gnamre of Seller Signature of Seller ✓-
Kenneth C Goldbach Idol(f 1'a 0111 Robin A.Goldbach f//f7 4 e./4
Printed Name of Seller Sian Date(.M.4/DO/YYYf Printed Name of Seller Sian Date(IMM/DO/YYYY1
F76UYER(S)/GRANTEE(5);;,APPLICATION.FOR.PROPERT•Y-,TAX*DEDUCTIONS_IDENTIE ALDITEMSTHAT.APPLI _-_;_i_711.,1 _,_
Jason P. Marceaux Kristin N. Marceaux
Buyer 1-Name as appears on conveyance document / Buyer/2-Name as appears on conveyance document
�'-Il0 G Qlt' Dt=Ttti'Q, Oc', Ql5 LP-I( & Old Pp67t.tt CS
Address(Number and Street) nAddress(Number and Street) U
POINA_LSUJ il) L17(.170 riAA•-1�`'Nt ) IJ (-f (070
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA .
YES/ NO CONDITION I YES NO CONDITION .,N t,
B ❑ 1.Will this property be the buyer's primary o- ❑ 3.Homestead `,,_ ;
residence? Provide complete address of primary n Is 4.Solar Energy Heatingya ling System;' F
residence,including county: ❑ 0 � tYY
446 E Old Petersburgh Rd S.Wind { nnD....r/
Address(Number and Street) ❑ igi 6.Hydroelectrrelr is., 'Device �IQ
Princetion. IN 47670 Gibson ❑ Q 7.Geothermal Enel Vii-. .• ooling Device
Ci ,StateZlPCode County y _31 "
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8 Is this property a res e,� '.1 re' I property?
vacated for this residence? If yes,provide ❑ Fl 9.Would you like to receive ti s, atements for this
complete address of residence being vacated, property via e-mail?(Provide rd.Qtact information
including county: below.Please see instructions for more information.
)401 AeNS e QA/R_`i c i Not available in all counties.)
Address(Number and Street)
r:VAIUS if I k-i-tr iAi 1-17711 do &S 3i Ay- oo�Cds-- ace 7
Ciry.State ZIP Code County -
Primary property owner contact name E-mail