Homestead_Racine (2) INDIANA SALESOISCLOSURE FORM SDF ID: _ Page 2
D:pREPARER = ;
Christina Ferouson `..- --Closing Aoenl
Prepvrcr of the Saks DbdvsureFom Tide
501 Main St.Suite 101 Bosse Title Company
Address(Number curd Street) Spam,
Evansville.IN 47708 812.421.4000
aty,State and DP Code
Telephone Number E-mail
E.FSELLER(Sj/GRANTOR(Sp:_ _`. -. -7. . — -
r
Aswan Harker by Max Henry Harker Attorney-In-Fart
Seller 1-Name as appears on conveyance document
Seller 2-Name as appears an tontxynmedovrmmt
455 Skore(tile Dr A-9+3oq
Address(Number and Sane) Address(Number and Street)
)C Spike, ?fa‘c, MIV 55-3 2Y
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Under penalties of perjury,)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 Acts.
1.
Signature of Seller Signature of Seller
Max Hervey Hacker Attomey-In-Fact ' 'S( )((I C
Printed Nome ofSeer Spn DateINM/DO/YYrn Printed Name of Seller Shm Date(Nte/DD/I'ITY)
F BUYER(Sj'/GRANTEE(SYY/tPPLICATIONIFORI PROPERTY,TAX.DEDUCTIONS°_IDENTIFYIALIPITE
l 'R Y
fP :=_:-_-_.1
Maxwell J.Racine t Ill
IOY � Boyer appears on conveyance
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reit(Num and Street) `_��� Addreu(Number and Street.) JUN .1 tub
rNLC d. ) -
YE NO CONDITION YES _
ig ❑ 1.Will this property be the buyer's primary Qr ❑ 3.Homestead
residence? Provide complete address of primary U U 4.Solar Energy Heating/Cooling System
residence,including county:
❑ p 5.Wind Power Device
Address(Number end Street) ❑ ji 6.Hydroelectric Power Device
ay sm eu➢raee ❑ IS 7.Geothermal Energy Heating/Cooling Device
County
RI ❑ 2.Does the buyer have a homestead in Indiana to be ❑ a 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: • • • ••• „ions or more information.
\a-1\ > C— Sj=^ Not available in oil counties)
oaten(Number and Street)
C r- r-Ce.'t e.N -y IV ' m c 1 CJ L •h .s a /Q 77
dry,Store LP Code °i� -/ ! -! ! ' /0 pt Oo0• d83 _� }-/
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