Homestead_Higgins (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
if":.PRE EAR ER"�,r� —��a�_`' �-����-' aZc �;�`=.=�=t�'.�'^'��='�.��'F:;"� _
Stacy Brown Closing Coordinator
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 - • Regional Title Services,LW - '
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555
City,State and ZIP Code Telephone Number E-mail
E'-:SEL•I:EftiSJ%GRANTOR(SJ :aiaM_: -,.. _.: a .•. t=-7.n7- 7 7:r:, „-..�„: .'.''N$ ._"_'._.-_-r�k:
Roger L Conklin Rebecca G Conklin
Seller 1.Name as appears on conveyance document Seller 2-Name as appears on conveyance document-
3003 W 1050 S 3003 W 1050 S '
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
and�.c plete a re. Jre d t y aw,and is prepared in accordance with IC .1-5.5,"Real P e 7 les Disclosure Act".
19 •tore of Seller ` Sig care of Seller
Roger L Conklin >-2'� (1 Reb cca G.Conklin c'24 •(1
Printed Name of Seller Sian Date(MM/DO/YYYY) Printed Name of Seller Sign Dare(MM/DD/IYtY)
i _ q -....
.E=BUYERIS)f.GRAN:TEE(S)_AP,P.liICATI0N;F0RtPROP.ER171'AX;DEDUCLtONS�UIENTIFY,AtiI:IT�: 4 y.
Joshua P. Higgins Melissa A, Hianins �• L =e
Buyer 1-Name as a e conveyance document Buyer 2-Name as appears on conveyance document
115785:150W. 11578 S. 150 W. MAY 3 0 2017
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 _ Haubstadt. IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION , y S Mn CONDI ION
Er ❑ 1.Will this property be the buyer's primary C, ❑ 3.Homestea
residence? Provide complete address of primary gy Heating/Cooling System
residence,including county: ❑ 0 5.Wind Power Device
I,CC7"3 W 1 % S
A.}�(e's�(Number and Sir -y�,�i –'1 (y�('� (� ‘10C ,. /'� ❑ 0 6.Hydroelectric Power Device
•�^^L1 AU}i y" - y +�'"J v(V�Y 1 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City 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 ❑ 0 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.
))5-75 5 / CO L✓ Not available in all counties.)
Address(Number and Street)
/ i 6s ll' `C\ ek - dd -03 -/00 -000.• 2/8-0X-4-1
City,State ZIP Code County
Prlma,y property owner contact name - E-mail