Homestead_Campbell (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
-DPREPARER--.„ _ �:r ._ ':'-_--_:-. ":•1 _- . . . ,.�u 'r:
Stacy Brown Closing Coordinator
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services,LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555
City,State,and ZIP Code Telephone Number E-mail
EFS CET R(S)`/GRANTOR(S)�_-7-7,&4111.12- — _,ae '1;2—'7 4 �'��s-59 `"-r. ..Fg, r z L _ 777I
Teresa M.Glaser
Seller I-Name as appears on can enonce document Seller 2-Name as appears on conveyance document
19700 Hwy 57
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
an complete as require. by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
ignature of Seller / Signature of Seller
-
• •
Printed Name of Seller Sian . e(MM/DD Printed Name of Seller Sion Date(MN/DD/YYn1
F.BUYER(S`JGRAN:TEEc sp-zAmteATimiE ORiPROP;ERT1rTARiDEDUCTONS_ DE crni AL TEM- T 3-5 --- _-__
1
William R.Campbell Amanda L. Campbell /�
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance docum Viv/ './
—111 f amphe.i ■ ac! .Same ,92
Address(Number ands eet) Address(Number and Street) 0/e O/J
LVG(1Sv i elr? , IN Li—I-
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. K
Y NO CONDITION
ES I d YES NO CONDITION
n 1.4Vill 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: ❑
I to eo S 'i(le, Tr�C, Or 5.Wind Power Device
Address(Plum rand Street) [ �,�-N ❑ 0 6. Hydroelectric Power Device
Up IIn3S 1-I TN 4—i 19�)C\ Gi U\V ` El 0 7.Geothermal Energy Heating/Cooling Device
Ciry tate ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be n 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 c.Li below. Please see instructions for more information.
ir ..d I 1 2r 4 Not available in all counties.)
Address(Number am Street) t
— ( " t • 1_ ag- as—, R300 00 /• .573 - adY
Ciry.State Zl.Cod- County
G.Allri I\ Primary property owner contact name E-mail