Homestead_Cooper (3) INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2
D. PREPARER 4
Becky King Closing Services
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd.. Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 becky.kinq(Wregionaltitlellc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)fGRANTOR(S)-
The Weber Revocable I iving Trust dated March 10 2003
Seller I-Name as appears on conveyance document Seller 2-Nome as appears on conveyance document
902 Mohawk Dr
Address(Number and Street) 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
Sand omplete as required y law,and is prepared in accordance with IC 6-1.1-5.5,"Real Prope Sales Disclosure Act".
� a2-- 7 's., ���� t i2m v / .ti
Signature of Seller S' nature of Seller I
James Don Weber Tnlstee 12/09/2016 Monica Anne Weber Trustee 12/09/2016
Printed Name of Seller Sion Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MH/DD/YYY11
F.BUYERS GRANTEE(S)-APPLICATIONIEOR PROPERTY.TAX DEDUCTIONS-IDENTIFY'• ; � H 1 , •• ' :
Shaun E. Cooper Kara : oo.- , .. . I
rs on conveyance document Buyer 2-Name as appears on conveyance document
13501 LITTLE BLUFF DR same DEC 1 3 2016
Address(Number and Street) Address(Number and Street)
VANCLEAVE.MS 39565
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary Q MI 3. Homestea�
residence? Provide complete address of primary Nou, 0 4.solar Energy Heating/Cooling System
residence,including county: ❑ NI
305 W Walnut St S.Wind Power Device
Address(Number and Street) ❑ NI 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ TA 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 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.
nt(wallah'',in nil rnuntips
Address(Number and Street)
6 - /i'-/3 -go 3 - o0o . 8 ' S- 0-14
City,State ZIP Code County
n c name ail