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Homestead_Egli INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 liC PREP.ARER` _ ------ - F 7— -- ---A-a `Y', • Peggy A. Ralston Title Assistant Preparer of the Sales Disclosure Form Tide 3101 N.Green River Road Suite 130 Columbia Title. Inc. Address(Number and Street) Company Evansville. IN 47715 812-471-8563 pralston Ocolumbiatitleoroup.com City,State,and ZIP Code Telephone Number E-mail E:SEI$:ER(S)iGRANTDR(S) `--Yr f ---- --- t=-_--- - --- - —77-T7'777.7.71 The Estate of Genevieve M Rlackard by Charles K Adams as Personal Rep by Bruce C Adams as AIF Seller l-Name's ap rs rnvo'ance day nt Seller 2.Name as appears on conveyance document 500 A >hienVf — Addres(Number and Street Address(Number and Street) 7300) ikl 11( ` ��°� Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and mplete as req i d by law,a prepared in a ordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Seller / Signature of Seller Charles K Adams P/R by Rnire Adams as AIF 5/15/7015 Printed Name of Seller Sian Date(M.M/DD/YYY11 Printed Name of Seller Sian Date(MM/aapYYYI :Fi BUYER(SVGRANTEE(S) APPLICATION.EOR PROPERJAX DEDU6T10NS=IDENTIFY,X114TEMSTHAT'APPLY-_ '. - j Kevin T. Egli Brooke C.Egli Buyr.I-A'ameas appears on conveyance davment Eller Name asapp rs on conveyanced ment �IOD tQS# .Sin dacrlff- l00 Ens%iinoltir c3 Address(Number and Street) Address(Nu ter and Street) -Met Brand) . 10 41601/V P6)- Ytrxick) hi ii-v,((3" 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 YES NO CONDITION JUN 1' - 2015 0 ❑ 1.Will this property he the buyer's primary 0 ❑ 3.Homestead JUN tJ residence? Provide complete address of primary ❑ 0 4.Solar Energyting/ oli m residence,including county: 400 East Sinclair Street ❑ IN S.Wind Power h�I COUNTY Address(Number and Street) ❑ 0 6.HydrooeBcmOc Foweer-Device AUDITOR Fort Branch, IN 47648 Gibson ❑ 0 7,Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 0 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. Not available in all counties.) Address(Number and Street) dlir I?—I8- 301 - DCZ, Din -CNo City,State ZIP Code County Primary