Homestead_Fleming INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
[BR REP,ARER1 _ __ -__ ---- :—_----- -------
Pam Hancock title administrator/closer
Preparer of the Sales Disclosure Form Title
221 NW Fifth St Lockvear Title. LLC
Address(Number and Street) Company
Evansville. IN 47708 812-421-8405 Pamela nlockyeartitle.com
City,State,and ZIP Code Telephone Number E-mail
LE.SELL'ER(5)/GRAN;T,OR(S);-. _177._
Cheri D. Page
Seller l-Name asa tars one nv nce document Seller 2-Name as appears on conveyance document
55 • 1
d ss(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 mpletei law,and i prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Cheri D. Page 7/10117
Printed Name ofSeller Sian Date IMM/DD/YYYYI Printed Name of Seller 1 Date(MM/DD/YYY11
EF.BUYER(S)%GRAICI TEE(SpiAFP,LICATIO—MiOR!P,ROPP,ERTI TAX• IEDUCTIONS. IDENTIFVAE InE H' (b ;
Dylan James Fleming
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyancl5Yun*nq 2017
Ztl S. RAce ST (e e-k- Jl1L 1 .1 C I
Address(Number and Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary
❑ 12 4.Solar Energy Heating/Cooling System
residence,including county:
Z 1 e1 S. dote Si t e e i ❑ 12 5.Wind Power Device
Address(Number and Street) ❑ 19 6.Hydroelectric Power Device
Pc; n(e ttn 1 V yl G 70 C'; G,son ❑ 0 7.Geothermal Energy Heating/Cooling Device
Dry,.State Zl ode County IN
ID 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 19 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 County .9(9-13-o'1-Yo/ Dol. 3 -oar
Primary property owner contact name E-mail
. '