Homestead_McEllhiney (6)INDIANA SALES
Laura Rininoer Clos
Preparer of lhe Sa/a Oudosure Form Tide
7820 Eaate Crest Blvd Ste 201 Reoional Title ;
Addras(Numherand5treetJ Company
Evansville. IN 47715
C�fPg� L. Rrar�i
Sefler 1- A'amr as appmrs on com�eyanre document
145A Amberwood CirclP
Addras (Number and5treet)
2- Name as aypears w ronveyance docvmen[
Murfreesbom. TN 37128 Murfreeshoro. TN 3712A
Ciry, Sm:q andTlPCode Ciry, Smtt md ZIPCOde
Under penalties of pey ' �, I hereby cer[ify that this Sales Disclosure, to the best of my knowledge and belief,
and compl req6ire by law, and is prepared in accordance with C'6-11-5.5, "Real Proper[y Sales Disck
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Signa[ �e Shcer � / J / tgnamreo(Seller
ii , i ie
Damon L. McEllhinev I Levyn M. Bertram
Bvyer t- Name as aypmrs on tronveyonte dotument Buyer 2- Name as appmrs on tonvrycn¢ do[ument
172 Washington SL 5603 N Old US Hw�
Addrw (Num6n and5[rttQ AdEras (Nvmber and SL
Newburah. IN 47630 Hazleton. IN 47640
Ciry, Smtt and ZIPCade Ciry, Smt4 and ZIPCade
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAII DEDIILTIOYS FOR THIS PROPERTY. IOENTIFY ALL OF THOSE THAT
Q✓ ❑ 1.4Vi11 this property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
AAd�� (Number an d Svee[)
Princeton. IN 47670 Gibson
Ciry.Smte Z1PCOde Counry
� Q 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding tounty:
Addrm (Numberand5tree[J
Clry, Smm LPCOde Counry
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3.Homestead �""'Cp�NKJ-k
4. Solar Energy Hea[ing/Cooling S�+
5. Wind Power Device
6. Hydroelectric Po�ver Device
7. Geothermal Energy Heating/Coo
8. Is [his property a residentlal ren
9. Would you like [o receive [ax sta
property via e-mail? (Provide con
below. Please see instructions for i
NoC available in all counties.)
=��3-��� - �a. �.=
owner ronmct name
ie, correc[
Act".
g Device
property?
nents for this
�C infarmation
re in%rmation.
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Under penal[ies of perjury, 1 hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, corred
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcY'. (No[e:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead ieduc[ion is
being�ed.) �� � /
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SignamreofBvye�7 SignaN� Buyerd/S�ouse � I / �
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flamnn I M�FIIhinPY
Pnnled Legal Name o/Buye� 1 Sign Dan (NN/00/YYY17
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License/ID/Other Num6er
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SpouseDriver's Sta[e
Number License/ID/OtherNum6er
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