Homestead_GipsonSalu Disdns�re Form
nue
��, �� ���_�� R��r� nuao DirectTitle InsuranceAaency Inc
AAdrus(Numberand5tree[) � Comyony
Evansville IN 47715
Ciry, Smtq und ZIPCode R/ephane Num6er
E�maii
Seller ]- Name as oppears an conveyance documen[ Seller 2� Name ar appmn on ronveyonce dotumen[
�l iE � i� l.J � j D.S
res (A'um6tr aad5uee[J Addrea (Nvm6er ond Street)
(.c�/lSOI 1(P T� �'71.1t �
Ciry, SmtS ondZlPCode
Tele honeNUm6er E-mall Tele haneNvm6er
E-mail
Under penalties of perjury, 1 hereby certify [hat this Sales Disclosure, [o the best of my Imowledge and belief, is true, cocrect
and cqmplet�as reguired�D� law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disdosure Act".
h%irr� ir 1 �" , � .,
o/se/ler
an convryonce documm[
L
THH SALES OISCLOSIIRE FORM MAY BE USEO TO APPLY FOR [ERTAI.Y DEDUCf10N5
Ll'f U 1. Will this property be the buyer's mary
residence? Provide comple[e dress of prim
residence, indudi county:
lala I li W 4—C�
�ddress (RUm6er vnd Street) /�
1�L� nS J l l l =.-. t��,l�� _ S L-� [� cv+-�
C�ry,SmteZIPC e Counry
❑ � Does the buyer have a homes[ead in Indiana to be
�vaca[ed for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (A'um6er and Str¢[J
Ciry, Smte ZIP Code Covnry
Slgnamr[of5eller
on
Z�
SmtG ondZiP Lode
APPLY.
❑ 3. Homes[ead
�+�}�4. Solar Enerev HeaxifS
+�' S. Wind Power Device
4�FQ
System
❑ � 6. Hydroelec[ric Power Device
❑ �' 7. Geothermal Energy Heatlng/Coofing Device
�❑ rQ' 8. Is this property a residentlal rental property?
❑ � 9. Would you like to receive tax statements for [his
property via e-mail? (Provide contactinformatlon
6elow. Ple6se see instructians for mare information.
No a ailabl in all countles.)
�� /o - ,3� _ �ao _ a� o. sa� - a�/
..+aryprvperry awner ronmtt nome E-mafl
Under penalties of perjury, 1 hereby certify [ha[ this Sales Disclosure, [o the best of my Imowledge and belief, is true, torrec[
and comple[e as required by law, and is prepared in acwrdance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[". (Note: .
Spouse informatio�So�i� Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
`-:- s. _ � ,
o(Bvyer]
Number
sjq� Hvyer /s /ys��
�b:'e� 1�1��,5 %�
PrfnttdLegalNameofBuyerl/Spouse
��
LastSdigiCSOfBuyerl/SpouseDrtvei's Smte LostSDigitsajSocialSecunry
Number License/1D/O[herNum6er