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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