Homestead_Breidenbaugh (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
'D.PREPARER' _ i - ' _ - ._
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 CHRISTINAOREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) - - -- _ - - -
Christoo -r D Ivy
- Selle { e as apnea ..%�eyance meat Seller 2-Name as appears on conveyance document
/ Sri yy
\/Address(Numbe ad Street) /- / Address(Number and Street)
A I SYS OSe, L ife Roo
X'�v�/rr//etry(�v/J�SSlate,and ZIPCod�ej / /� Ciry,State,and ZIP Code
,.CCn1/rdi r,61 T) 7o g7,2.3(5-53/3
}elephone Number E-mail Telephone Number E-mail _
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
.lid co 1 •to as required b law,yyy- d is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/
/ a .:
. ' , -
Max Breidenbaugh Kellanv Wright
1 Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
X 2• i-O kdo CI— AjI It Jlao elanknn Co,Lrt (Apt- (9
Address(Number and Street) Address(Number and Street)
Pr ce1ak". 7N t+767d Qc;
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT PLY.
YES/ NO CONDITION 1 YES(/ NO CONDITION
- eg ❑ 1.Will this property be the buyer's primary u ❑ 3.Homestead
residence? Provide complete address of primary
❑ Fl 4.Solar Energy Heatina/Co lipg rr�
residence, including county: ❑ l
1546 Outer Lake Rd. S.Wind Power Devic
Address(A'u er and Street) ❑ Fl 6. Hydroelectric Pe ver Device?
Princeton IN 47670 Gibson ❑ 0 7.Geother' tc :'tea; Heating/Cooling Device
City,State IP Code County
4 ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this propertfg,t�,.'•'.. ental property?
vacated for this residence? If yes,provide ❑ 0 9.Would you like to redee)'ve oix statements for this
complete address of residence being vacated, property via e-mail?(ProvlaPigoltact information
including county: below.Please see instructions for 17dlore information.
Not available in all counties.)
Address(Number and Street)
W4,' a — o9 io3 CO i .51V 'o0 , 7
City,State ZIPCode County
Primary property owner contact name