Homestead_Grady INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
L`- iP�REPARERi•.^.c *^";fir. ,r . .' . ' F t., . AC;-_ 6. - _7,77- lil V, `I
Stacy Brown Closing Services
Preparer of the Saks Disclosure Form Title
7820 Eagle Crest Blvd., Suite 201 Regional Title Services,LLC
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 stacy.brown @regionaltitlellc.com
City,State,and ZIP Code Telephone Number E-mail
RSELLER(Sj/GR'tY\TiOR(S)�., z "-, . .. ,;ft==s+ - . ih :.. :=-v.
Kenneth C Gnldhech Robin A Goldhach
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
t,�AAdddress(Number and Street) f'� Ad res uh mttt ''H Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as requir• A by I. v,and is prepared in accordance' -th I -171-5.S,"Real Pro e Sales Disclosure Act".
Signature of Seller Signature of Se ler 1
Kenneth C Goldhach 5\e°1111 Robin A Goldbach 31°1 \IS
Printed Name of Seller Sign Da (MAY/DD/YYYI) Printed Name of Seller Sign D e(MM/DD/YYYYI
(FpfaixER )'/GRt1 EEssfs PpLtGaucmt$(J_RIP.RQPERTSyg7rAN oEris.E.oNslimE_Nifil llrL(ITEMSi[itkrriArp.P,Lrt " ` ` 'i�
Teresa K Grady i
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance documen
3443 Minor Road _
Address(Number and Street) Address(Number and Street) -_ :• It
Spencer, IN 47460 - MqR 1
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT AP' & Nj111,
•
YES NO CONDITION YES NO CONDITION "ion,).
2❑ f Will"U`ns p` roplrrty be the buyer's primary j,/ ❑ 3. Homestead
residence? Provide complete address of primary ❑ 121 4.Solar Energy Heating/Cooling System
residence,including county:
(OZ0 C 1c)d. 2 , ❑ 12 5.Wind Power Device
Addr (Number and Street) (� ❑ 6. Hydroelectric Power Device
rincc fp h I IN 41(rib 1jl In ❑ ❑ 7.Geothermal Energy Heating/Cooling Device
City State ZIP Code County
❑ 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 ❑ IA 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including c nty: below.Please see instructions for more information.
3'1113 minor PO/ Not available in all counties.)
Add (Number and Street
,S)enccv t //J LiWbO ,O Nat- Z 6,-/.7 -o7 -Zo 9 000755 0 ,R S-
lily, ate ZIP Code County
Primary property owner contact name E-mail