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Homestead_Collins II INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 ri lDAP.REPARERY" !t W r :iFtJ`.:t,, ? '> "�v ' Wi r s.' t_ ' '_ Stacey Salzman Closer Preparer of the Sala Disclosure Form • Title 4962 Lincoln Ave. First Advantage Title Address(Number and Street) Company Evansville, IN 47715 812-490-8485 Iheteam(&firstadvantagetitle.cor City,State,and ZIP Code Telephone Number E-mail EaSEiI[!ER(S'yGRAN;TQR(S)t+T Zt.tr' .'t?-"exi°'Rx"r:?-}-'sT'kr 3. Yt" S}�u_ r%.,ttaf._—°,,`—.zszi r:,-a-c—cam ^c. - I ri <.w�is_.:i�. -n��.-y'�1ar^.9��„(1LC1V.2F'fY�'�i'its� IMO ■cK-.1\ '1■ •In ►\r' . . Seller);Name as appears on cony nee document Seller 2-Name asa can on cony tt �u(`--1 (��pp{Y����l 1 R t� n k PP conveyance document• A ber and5treet) (IF) gddress(Number and Street) Lk-M \ ( Under penalties of perjury,I ore y certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and completquired law a is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". q Signature of Seller 0\-1 (\cON - f(VC, to II f� Printed Name of Seller -- Sign Date(NN D/YYYT) Printed Nome of Seller Sian Date(NH/DD/YYYY) ingrYErcOG6QtJ17iEE(S)= Rg11IJiA[@(QM.RTEROPr INSI'[�t X4f)EDI[Czf O� inI IFl 8 1;'EEMSRFIKf P,P, al4atif'F:CS:,J��r» .7 JU �-11 ILL ( Coo1 ) N. �� n ' ' U&, COO ; . BuyrI-Namears on conveyance document B9I 2-NY��� cc 3 I i appears conveyance document V � I> r. �� (Number and Swett) (� �� Address(Number and Street) I n e s: --(N . FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR T1115 PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.( 1 j {qy n9 YES , NO CONDITION YES' NO CONDITION N ET ❑ 1.Will this property be the buyer's primary Eic ❑ 3.Homestead JUN 1 1 201 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooli System 5 3 r})nut ),includ' county: �1 _ ❑ D S.Wind Power Devic�lBSO ess[N andsw� , \0� lri/^1G ( -I t i,, ❑ Q 6.Hydroelectric Power Devit COUNTY I1IT 1 I �? I �l \,County (�❑ viz 7.Geothermal Energy Heating/Cooling Devi d OR Gry,State ZIP Code ❑ ❑ 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 ❑ RI 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 • all counties) Address(Number and Street) / City,State ZIP Code County c'41%--/07—/7 o 1/41- ood.o � -oJ? Primary property owner contact name E-moil