Homestead_Schrodt INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER . .,
LANA C. HARPER CLOSER
Preparer of the Sala 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 E-mail
E.SELLER(S)/GRANTOR(S) ' ' , :!' ; , . .evw'.'• ' :',- f._ '1`'. - , , .,,,., - -i".
ROSFMARY E GENT TRUST
Seller anvryypre documen Shcer2-Name as appears on conveyance document
Address(Nu'rJm///bet,cco t) ((��)),,""// 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 re iced b law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/\I 4n-414s Seller ?r 12foa
lure ofSeller A Signature of Seller
;Ice)'Kan; C Ee -1 7>as-lie S-/S/S
Printed Name of Seller Sign Date(MM/DO/YYY17
YES NO CONDITION YES • • • s ' a
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead IcCOUNT tljj,
residence? Provide com leteaddressof primary GIBSON COUNTY AUDITOR
/y t1} P P ry ❑ 5 4.Solar Energy Heating/Cooling System
loop C e ie Includ. itty. ❑
S.Wind Power Device
A (Number street) . ( / L ' ! ❑ 0 6.Hydroelectric Power Device
/'�u 7V / /N 417(076 /�U � ❑ IS 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
NI El 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 ❑ 5 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
�ncluAdIing coon ( below.Please see instructions for more information.
/9/ ' J u'tcy,nf l d�)r/))e Not available in all counties.)
ess(Number and Street)
PIncb71 /Al . 747D 019,560 ,2(, -/d -06 - Lr0/- 00/. 860 - .0 1- 8
City,State ZIP Code 1 County
Primary property owner contact name E-mail