Homestead_Johnson (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(dREGIONAL-LT.COM
Ciry,State,and ZIP Code Telephone Number E-mail
E:SEL'LERIS)/GRANTOR(S) :T _ -.'. _-.: ' . . r_ :7--,'l ,-4 11 _ . . _
Wendell J Bean Jr
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1OL12_ 6 SSTs .
Address(Number and Street) (he
Address(Number and Street)
���111111er penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a omplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
N.
Signatu e of Seller Signature of Seller
Wendell J Bean Jr 1.-1C- 11
Printed Name of Seller Sian Date(M.M/DD/YYM Printed Name of Seller Sian Date(MM/OD/YYYI)
E _R .z-,.`r`.
F'BU,YER(S)/GRAN'TEE(S '_APPUGATION.EOR PROPERTY;TAX DEDUCTIONSIDENTIFYALLITEMSITH'AT'AP.PLY �y __
1
Angela D. Johnson ' •
a a apprIons ante document Buyer 2-Name as appears ' ronv on •doa nt ill
d ros mbera d ee Address(Number and Street) 0 7017
( aznP �
THE SA DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTI THOSETHATAL.
YES NO CONDITION I YES NO CONDITION
Q 1.Will this property be the buyer's primary l�J ❑ 3. Homestead
residence? Provide complete address of primary ❑ is 4.Solar Energy Heating/Cooling System
residence,including county: ❑
8909E 550 S S.Wind Power Device
Address(Number and Street) ❑ N 6.Hydroelectric Power Device
Oakland C.y, IN 47660 Gibson ❑ N 7.Geothermal Energy Heating/Cooling Device
City,St Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8. Is this property a residential rental property?
State
vacated for this residence? If yes,provide ❑ N 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)
City State ZIP Code
(CG— o—ID- loo-Oco- /9`3-f (
»
County
Primary property owner contact name E-mail