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Homestead_Lancaster Jr INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 jD,P,REPARHRr71- _... - ;;r » t.- w CHRISTINA LATHAM TITLE CLERK Preparer of the Sales Disclosure Form Title 4703 THEATER DRIVE REGIONAL LAND TITLE Address(Number and Street) Company EVANSVILLE, IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT.COM Cry,State,and ZIP Code Telephone Number E-mail [EE SELLER{S)/GL2ANTOR(S)'_° -' -;"•----- `J..>. -1=1-1 11. ' -` ,_, a' - 77-°7 -.-- : ;-. - . Dustin W Rogers Seller l-Name a appears on co veyance document Seller 2'Name as appears on conveyance document !<?js Al tom' a LACfess(NumberandStr:) 1 L Address(Number and Street) r\ Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct a complete as required by, l�aw,and^is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". CSi3Zi Lure Of Seller-4 L.--- Signature Signature of Seller Dustin W Rogers 3-j a'` j 6 Printed Name of Seller S(qn DateikM/DD/YYYI Printed Name of Seller Sign Date NM/OD/MY) E:-) 5 ',G RANT EE- )SAPPLIGATIONIEIT!,PRO P.ERTY.TAX.DEDUGT ION S IDENTIFYiAI.GITEMS1THAT;APEL'T.T.. ' ---- Marty S. Lancaster. Jr. . \ Buyer 1-Name as ap•• -- • conveyance document Buyer 2-Name as appears on conveyance document -fie eF Cet) �' S�. _kit Add-•(NUinbe--rid Street) Address(Number and Street) p o,,, eesv,(4 .flU C/7(6C THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSUVItah,]P • `YES-&NO—C Y s,_CONDITIO; /,1 COUNTY ❑ 1.Will this property be the buyer's primary �❑ 3.Homest--, qV �i�//1���"' residence? Provide complete address of prim-a 4.Solar Energy Heating/Cooling System TOR residence,including county: ❑ IS 604 East Clark St 5.Wind Power Device Address(Number and Street) ❑ IN 6. Hydroelectric Power Device Owensville. IN 47665 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device Ci.,State ZIP Code County ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ Fl 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. 316 nrri AI «rss a.•. Not available in all counties.) Address(Number and Street) /y.�1 ,{ 7 Eva•u'v7/6 / SAJ C/7711 C -/OP:O 7/)/(�.F/. 1:07-©07� City,Stare ZIP Code County Primary property owner contact name I E-mail