Homestead_Wilson INDIANA SALES DISCLOSURE FORM SDFID: Paget
Stacy Brown Closer •
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services _
Address(Number and Street) Company
Evansville,IN 47715 (812)759-5555 closings @regionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
d"'r.4 .razes - ?3.?t-tr ?>*:'W f" a --•.ice c� y z.3d{rt a sY.Fv:-r+-z _:14,''i< °n3Ct;�+�nr._ Z r3M �yF. _
+�. IT-
Steve A. Daywalt
Seller I-Name((a�'s appears on conveyance document Seller I-Name as appears on conveyance document
O`.�l\ ODseYc(-k- hr.
Add'rev-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
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
gnature of Seller Signature of Seller
Steve A. Daywalt -( la-61 la
Printed Name of Seller Sign Orte`thM'/UfinYn) Printed Name of Seller Sign Date(MM/DD/ITTY)
gRAI MERf+5MWA irTE R 'ARP11GgitiniROR P OREtt+∎itt:AXTi)ED(1G>,P Oi\S"11DENTiRSI LI MEMS:tiHAt(s'A`IffI Y -}; --=
Scott E. Wilson
Buyer]-Name us appears on conveyance document Buyer 2-Name as appears an conveyance document
400 S West Lot C FILED
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639
GIBSON COUNTY AUDITOR
YES NO CONDITION YES NO CONDITION •
El ❑ 1.Will this property be the buyer's primary (y� ❑ 3.Homestead
residence? Provide complete address of primary ❑ El 4.Solar Energy Heating/Cooling System
residence,including county: ❑
704 N Roosevelt Dr 0 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Fort Branch,IN 47648 Gibson ❑ RI 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 0 8.Is this property a residential rental property?
❑ g' 2.Does the buyer have a homestead in Indiana to be ❑ El 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide property via e-mail?(Provide contact information
complete address of residence being vacated,
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Numbe rand Street) Scott E. Wilson db'15-13-
-ODL raa-
City,State ZIP Code County Primary property owner contact name E-mail -