Homestead_Dehosse INDIANASALES DISCLOSURE FORM SDF ID: Paget
SDIPJ2EP,ARER' ..,SS.'�"� $s �e',r�.- a:Y ate?Vra an
THOMAS L.MONTGOMERY GENERAL MANAGER
Preparer of the Sales Disclosure Form Title
101 PLAZA EAST BLVD., STE. 102 TRUE TITLE SERVICE,LLC .
Address(Number and Street) Company
EVANSVILLF,IN 47715 812.402.6555 closings(Uruetitlein.cam
City,State,and ZIP Code Telephone Number E-mail
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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 D' closure Act".
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Signature of Seller Signe ter
DEBRA LOUISE DERR 05/ /2018 - JO , A JAME • ' AN 05/-/, /2018
Printed Name of Seller Sign Date(NN/DD/rn•Y) Printed Name of Seller Sign Dote(ADVDD/rrn)
EsBU.YER(Sl/GRA7'EEL SAP.P.L�ICATIOT.FORaP.ROP.tR;TeY:e�AXiDEIlU'CTI01\S'`-�IDE1\'TIF.Y3ALLrSITEN'"ISvT>HA•T�ARPL-YE .w.�' SS
AARONDEHOSSE -
Telephone Number �ry?2� Ea
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OFTHOSE(LtHAT AP �O)&
YES NO CONDITION YES NO CONDITION '"rtIS�NA
❑ 1.Will this property be the buyer's primary �❑ 3.Homestead UNTy
residence? Provide complete address of primary ❑ H 4.Solar Energy Heating/Cooling Systr@rq-
residence,including county: ❑ H 5.Wind Power Device OR
520 N-150 W
Address(Number and Street) ❑ 5 6.Hydroelectric Power Device.
Patoka 7666 Gibson ❑ B - 7.Geothermal Energy. Heating/Cooling Device
City,sta a code Canny
❑ V 8.Is this property a residential rental property?
❑ Z.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, below.Please see instructions for more information.
including county: N t avail le in all counties.)
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Address(Number and Street) AARON-DEHOSSE - - -_. . - _- __ . _ _ —.- _. .
Clty,State VP Code aunty primary properg'owner contact name E-mail
.