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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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CHRISTINA LATHAM TITLE CLERK
Prepare:of the Sala Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE.IN 47715 812-402-4553 CHRISTINAeREGIONAL-LT-COM
Cry,Sate,and ZIP Code Telephone Number E-mail
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Krystal D Griffin,r1").3.1 V-4tgy)n &S kl .is4ki t7. e_cal 1\'2
'OS a- Name a?lie=on conveyance document seller 2-Name a appears on conveyance document
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drys(Number and Strna) Address(Number and Sbeet)
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Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an con ete as req eel by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Signature of Seller
;Crustal D Griffin I f\Nw''SUS?e b.Q.0- `4..X
Printed Name of Seller Ran Dare(toe/DD/YYYn Fitted Name afSeller Sian Date(ice/CO/YYYn
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE TBl7 6PPt--.t 2016
YTS O CONDMON YES O cONDmoN �V�/-Ill J
z❑ 1.Will this property be the buyer's primary YES
3.Homestead n,
residence? Provide complete address of primary ❑ is 4.Solar Energy-n•/{�a/ehL stem
residence,including county:
201 W Mulberry ❑ 5.wind P�l r BOUNTY AUDITOR
Address(Number and Street) ❑ El 6.Hydroelectric Power Device
Princeton.IN 70 Gibson ❑ Fl 7.Geothermal Energy Heating/Cooling Device
City,State ZIP e 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 ❑ IN 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.
/ /� Not available in all counties)
Address(Number end Stress) ath— l J -O() -30q -( 0_3 ^ -/-
Cary,State VP Code County �r/�/Jt'A/{/Wn/ CA •(-7�J�[J Qty
Primary property owner wraa name E-mail