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INDIANA SALES DISCLOSURE FORM SDF ID: •-•e 2
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CHRISTINA LATHAM TITLE CLERK
Prexrer of the Sales DS:1=n Fenn Tide
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(a)REGIONAL-LT-COM
Cry,Sate,and ZIP Code Telephone Number E.rail
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Jeffrey Wayne Mayberry
Seller 1-Name as appear on c- veyance document Seer 2-Name as appcn on conveyance document
g Add!!-(NF . and 4,-) S .' L • Addrm(.Nornber and Street)
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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 required by law,and is prepared in accordance with IC 6-1.1-5.5,°Real Property Sales Disclosure Act".
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Signature of Seller -et Signature of Seiler
Cherie Lynn Mayberry Attorney-in-fact 5- 11-1- ‘,5
Pitted Name o(Seler • n Dote •D Printed Name of Seller Dare a
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D. itI : - : °.2AMMI iN'44 Emily L.Sisk
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TEE SALES DISQ•OSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE TEAT APP
YES no coaomoN •_. t - t
GIBBON COUNTY AUDITnP
❑ 1.Will this property be the buyer's primary M ❑ 3.Homestead
residence? Provide complete address of primary • a o - Energy Heating/Cooling System
residence,including county: ❑ O
2339 Miller Reed Ln_ 5.Wind Power Device
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Address(NunherandS✓eey ❑ 0 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ 12 7.Geothermal Energy Heating/Cooling Device
at/StateZIP Code Cctmy
LE ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
c2» 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
Q including county: below.Please see instructions for more information.
(1D Vnt trvnliaible injif.counties.
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A (Nunnberan )
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cc e?m bScA- a A,-05 -31 - 2.0o 003. 818-o a )
eV,Stare ZIP Code r County
1,.e m• • •..-., owner contact tame --mall