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a/the Svlu Disdosvre Form �y��
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Evansville IN 47715
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Shcer ]- Name os opyears om m�vryonce dxvmen[ Shcer7 - Nome os appenrt am m�veyonce docvmen[
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Under penalties of perjury, I hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, torrec[
and comple[e as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disdosure Act".
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THE $ALES OISCLOSURE FORht MAY BE USEO TO APPLY FOR [ERTAIY OEDUCI'IONS FOR THIS
�❑ 1. Will [his property be the buyer's primar �
residence? Provide complete address prima
residence, indud' coun
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❑ 0�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 county:
Address (Num6er
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�Q 3. Homestead
APPLY.
System
5. Wind Power Device
❑ o- 6. Hydroelectric Power Device
❑ Q'7. Geothermal Energy Heating/Cooling Device
�❑ '� 8. Is this property a residential rental property?
❑ �9. Would you like to receive tax sta[ements for [his
property via e-mail? (Provide contoct information
6e(ow. Pledse see instructions jar more information.
o[ available in all coundes
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�ury yi uyeray owner [9nfGR nakle E-TOII
Under penaldes of perjury, 1 hereby certify tha[ this Sales Distlosure, to [he bes[ of my Imowledge 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 Act". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduc[ion is
6eing fi�led� � . �
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'nted l� I Na .ne of Buyer l � Sgn Dote (MM/oD/YYY1)
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