Homestead_Dilbeck 11,1DIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPAR ER I - '.fiki 15Il('la) � ` gyp NJ
CLOSING AGENT
Preparer of the Sala 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
:E,SELLER(S)/GRANTOR(S) - -- '
Jeremy Wayne Robb Jennifer Nicole(Payne,)Rohh
Seller -Name as appegis s— na acumenr/( J �Sd/erT-Name as appears on conveyance document
Address( u her and SS tetq ) �f(`/-'VJ 5/Y� Address(Number and Street)
L('�ry/{ter ' _�1 �2 X
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and c:0,,..: ete as requir• • r•:•.•w,and is prepared in accordance wit"-IC 6-1.l-S. "Real Property Sales Diiclosu Act".
% /\)
G— /._- x -ALA i• �( 1, Pare
/I�e
'gm-,re of Seller / SBnfrtdre of Seller 0 I, •�,,
,hammy Wayne Rohh Ca'"/�(P/ 1 Jennfer Nicole(Payne)Robb X 4?"-30-o4Jl 7
Printed Name of Seiler Sign Date 01M/0o/Yrr11 Printed Name of Seller g--a Sign Date(MN/oo/YYn)
F.BUYERS)/GRANTEE(S)--APPLICATION FOR PROPERTY TAX-DEDUCTIONS-IDENTIFY ALL MJTIAT'Pi ,Y ,,-. - .
/' Adam Dilbeck Annie Dilbeck —11,,,aT
1 n7 1 , as appean on conveyance document Buyer 2-Name as appears on conveyance document
1233W8008 1233W800S FFR 22 21118
Address(Number and Street) Address(Number and Street)
Ft.Branch,
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 CONDITION
Q ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestea
residence? Provide complete address of primary ❑ Heating/Cooling System
et/ n 1 re$idGnci dingcounty:
(/�l 5' ❑ p 5.Wind Power Device
(Qdr sdstrtet)/ A , / Z/-� S 6'/_o- ❑ 0 6.Hydroelectric Power Device
Uttlein Ciry State ZIP Code Gl(P t-( (O(O CJcaanty ❑ p 7.Geothermal Energy Heating/Cooling Device
❑ Iv(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 ❑ El 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)
16. -17 - o3 -1,00 - 00.3. 7 01 (0 - 0 d- I
City,State ZIP Code County
Primary property owner contact name E-mail