Homestead_BrockChristina Ferquson
Neparer o( the Sala DSdosure Form
507 Main St. Suite 101
Addrgs (Num6er and Svee[)
Evansville. IN 47708
Ciry, SmIG and ZlPlode
Seller 1- Name as appears on ronveyvnce dorumenl
��%.� ) iAr 1, a• � i��D-G'
Addras(NUmbe�and5tr )
D�.,,;Y._r �„ IiP . /N `—,' �GG !
Ciry, Sla:q and7JP Cade
Tide �
Bosse Title Comoanv i
�
Jane Gonver
Selle� 2- Name os appears on ronveyance dorumm[
[iry,
Under penalties of perjury, 1 hereby certlfy tha[ this Sales Disclosur �e bes[ of m knowledge and belief, is [rue, correc[
and complete as required by law, and is prepared in accordance th IC 6- .1-5. " roperty Sales Disdosu�re Act".
1/.a-,( �'• J..Z,r-.�� ( I
Signa2reo(Seller Sign o/Sd/er I _ ,�/
Todd W Gonyer 11' I-�' /S� i �j j�
Bvyer 1 -,Vameas
Princeton. IN 47670
Ciry. Sm:G and Z/PCade
Buyrr 2� Name as appn
812 Bia Hooe Trai
Address (Numberand5o
'rinceton. IN 4767(
Ciry.Smte. andZlPlode
THE SdLFS OISO.OSURE FORM MAY BE OSED TO APPLY FOR CERTAIY DEDURIOSS FOR ALL
Q � 1. �Yill this property be the buyer's primary
residence? Provide complete address of �
residence, including county:
1082 S Old State Road 65
Addr� (Num.ber and Strre[J
Princeton IN 47670 Gibson
Ciry,Sm;eZ1 ade Counry
� 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, pro��de
mmplete address of residence being vacated,
including county:
Addr¢s (,Yum.ber and Stree[J
[iry. Smte21P lode Counry.
Q � 3.
t j-- 7�h-SoTar Energy Hea[ing/Cooling Systeni' UR
� Q S. Wind Power Device
� ❑✓ 6. Hydroelectric Power Device
❑ ❑✓ 7. Geothermal Energy Heatlng/Cooling Device
� Q 8. Is this property a residen[ial rental property?
❑ ❑✓ 9. Would you like to receive [a�c statements for [his
proper[y via e-mail? (Provide contar[ information
below. Please see instru[tions for more informadon.
Not availa6le in all counties) I
E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, isi rue, correc[
and comple[e as required by law, and is prepared in aaordance with IC 6•11-5.5, "Real Property Sales Disclosure Ac[". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homes[ead Dei uc[ion is
being flled.)
� a ����
n.s��- , � �,. k- a. � 'G�/1z�
Sig amreafBuyerl S�ignaNreo(Buyv2/ ouse I
Inhn F Rrnrk .Ir �!/.� /j i� Tam Bronk
PnntcNl,ega1Nameo(Bvyerl �gnDate(M.N/00/YYYY) Pnn[MLegalNameo(Buyv2/Spouse
!D/OtherNum6er
o(Social Secunry