Homestead_Heltsley INDIANA SALES DISCLOSURE FORM SDF ID: Pagel.
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CHRISTINA LENFERS CLOSING AGENT
Preparer of the Sales Disclosure Form Title
501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 812-421-4000
City,State and ZIP Code Telephone Number E-mail
FE:sETAIER(slytifilwroR(S)-117i. CI':_17,-__-_ ::". :,:,: .,R;1: :-.7-.727 77,---7-: --._. .____:, Ty ,.,a
PATRICK.! HOMMRICH
Selig I-Name as apprs on conven;ccclocument Seller 2-Name as appears on conveyance document
3 anen 6 S Ct._ bir-
Ack ress(Numbe and Strebit— 3:ki tfrl 40 39 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.,$o• •is I- e •s ired by la nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
, Illr
n 4160
L o
Signature•riff Signature of Seller
PATRICK J HOMMRICH 06/22/2017
Printed Name of Seller • Sign Date(1-04/PD/YriT) Printed Name of Seller Sian Date(Mst/DD/rrrY)
W..IBUYER(SVGRANTEE(SWAP,PhIGATIONIEORIPROPERT:Y.fFAXTiEDUETIONS=LIIDENT:IFYIALLTTEMSTHAVAPELY:Z_L._ - --777. 77:
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Buyecl,Name as appears on conveyanehl u nt sr Buyer 2-Name as appears on canveyanc
104
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Address Number on Streebizi4.- x.t1/4.) Si 4 3,9 Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLYJ u N 3.0.2012
YES/ NO CONDITION I YES / NO CONDITION
0 LI 1.Will this property be the buyer's primary a p 3.Homestead
residence? Provide complete address of primary 0 2' 4.Solar Energy Heating‘Catiar-
resi nce,including county. ON COUNTY AUDITOR
ic
0 ii( 5.Wind Power Dev9c113
II 1 1 . A-
Adi3eabnefk .7iLit If1(4131 6,:b5-tin Fi ly 6.Hydroelectric Power Device
EI l3" 7.Geothermal Energy Heating/Cooling Device
City,State zip Code County
0 8.Is this property a residential rental property?
El LE 2. Does the buyer have a homestead in Indiana to be
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) '
19 C 0--I (IR -362- 9()3-COD.3 Lici -0f8
City,State ZIP Code County
' Primary property owner contact name E-mail
'