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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
EC PtEP.ARERa''€.a relz 4'3vti 4„naf _rra"a ` atV, 4t' .,'_Kar` z ?`-.,aad `= .VYV: a`;.::
LANA C.HARPER CLOSER
Preparer of the Sales Disclosure Form Title
5231 Oak Grove Rd., Ste.A TOTAL TITLE SERVICES,LLC
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-468-8485
City.State,and ZIP Code Telephone Number E-mail
'E-SELLERS)/G RAW T.OR(S) I _su:``'TaY"'"�''.` -. . ` tn+ .:v.� -?:.t.. - s `rrc-iaid . Si��_ ,. %.r :friTh7i.cR.
Jeffrey A Lewis Barbara L I ewis
Seller I-Name as appears on conveyance docu eat Seller 2-A'ame as appears on conveyance document
hi b. Poplar ///
Address(Number and Stree Address( rat. /I �l
Fort Orarelt,
' Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a d o plete as required by law,and is prepared in accordance with IC 6-1.1-5.5 "Real Propert Sales Disclosure Act".
Ay a tr o Seller a Signature of Seller 99
JePreya Name t-- -_( ) T- Sin Date OfMAI l� _R Printed Name of Seller — - - - _ ion Date WM/ Y
F'BUY-ER S GRANTEES _,APP,I:IGATIONIF,OR PROPER'f iTOOED.UCTIONS IDENTIFY,?ALI dt,EMSaTHi1T/ � 1ATI -°'^
Blair A.Name �
B erl-Name as appears on ronveyunce document Buy erg-A'nrneas appears an ronve)nnce document
gla - alit 2u/zd G� Nok j
Address(h'umberand Street) / y�� Address(Number and Street) < O
H tI)sIlXth 1 G/
TIIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. e,0/TO
YES NO CONDITION I YES NO R
Ue' ❑ 1.Will this property be the buyer's primary C ❑ 3.Homestead
residence? Provide complete address of primary gra . i , rgy Heating/Cooling System
esi ence,including county:
107 ( Poplar St 0❑ 5.Wind Power Device
_ clress,(NurnpSrtun Sara //V 1f7/ /�/� � ❑ 0 6.Hydroelectric Power Device
/T�( (.��L /�///)�1 1.L1 Y" lv ( ri IN 7.Geothermal Energy Heating/Cooling Device
City,State ZIP C County
❑ 2, Does the buyer have a homestead in Indiana to be ❑ 0 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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) �/ �M
Ciry,State EP Code County C'�' -/g-d iA - Cwo. o90 - o7�
Primary property owner contact name E-mail