Homestead_Reinbrecht (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER . - _
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
_4701 THEATER DRIVE - REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(tilREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S]_. -- - '-` '- - - -�--• -. . � `'- — -. ._ __':.:.,._...r .-.S :•. -_.
Jace A Blankenherger
%Seller l-Name as appears on cony ace document Seller 2-Name as appears on conveyance document
X50/ 611505
res (Mum ands eat) Address(Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an. corn. -teas required by lawir nd ill repared in accordance with IC 6.1.1-5.5,"Real Property Sales Disclosure Act".
sl.4 s�- • % �., Signature of Seller
ll
Printed Name of Seller Sian I Tee(HM/DD/YM)... Printed Name of Seller Sian Date(.N.M/aD/YYYr)
'F:BUYER(SyGRANTEE(S)_APPLICATION.FOR PROPERTYJAX DEDUCTIONS-.IDENTIFYALL ITEMS THAT APPLY
Jacob -Name as appears oFI
XBu erl-Name as appears on conveyance document Bvyer2-A'ameas ap to v nee o m [
)�I_97 _5 3.)o �, c±
�ren(Nt mbeFdnd Street) Address(Number and Street)
�1r��
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDEA PAPI clIgIS. t&YAMPITOR _ -
YES— LNO' I YES ENO CONDITION
❑ 1.Will this property be the buyer's primary ❑�3 Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ t.
10197 South 350 E 5.4�Ind Power Device
Address(Number and Street) ❑ Fl 6. Hydroelectric Power Device
Haubstadt, IN 47639 __ Gibson_ ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State Zl Code County
ED 2.Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes,provide ❑ 151 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 and Street)
a (0 .- 9 - 34-*tba -000ryLatag
City State ZIPCode County
Primary property owner contact name E-mail