Homestead_Keller (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
tORR-EPARER= • 1 ra M'.. '7 5 . a;M- . -'rsr Ai''', in."- ,, ? . ,.,n,' ??'Ts -e
Kim Loesch Processor
Preparer of the Sales Disclosure Form Title
2301 N Burkhardt Rd First Advantage Title
Address(Number and Street) Company
Evansville, IN 47715 (812)490-8485
City,State,and ZIP Code Telephone Number E-mail
iE4SEELER(S..GRANRIOOR `v ,a.-.,,. :1-' emu.-r 4+ ---'::-ntit .`..=''n , .i� r ,P. ;a,..: ?7`7
Robert R Fulling
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
/ 3 ST G1inrte J r 2---.
Address(Number and Street) Address(Number and Street)
ti a per ,Cr- y7.5-76-
E-mail
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".
Signature of Seller Signature of Seller
Robert R Fulling 06, /e'P,iZe; g
Printed Name o Seller Siam Date MM .DVy/ Printed Name Seller 11EIX Date MM 00/1771
IFIRT ' ?.T_R'i1NTIEE3teTi LTIG¢TION(F,OR4RROPERVaTe DE211:E ON 115ENITIFtYsALIT :(j�E .,1� ' j�� ; '.c'-'$';r7 -s
Jarrod A Keller -
V. Ar weya ce do<umrT A�/' Buyer 2-Nome as appears onconveyanci dp[ym*nt1 2018
�(�( N/� �)IV 1 D
Addrep4Nu her and
�� fir• i r/69 Address(Number and Street) c,
Lon
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES CONDITION YES 'O CONDITION
I.Will this property be the buyer's primary — 3. Homestead
residence? Provide complete address of primary L 151 4.Solar Energy Heating/Cooling System
/d/„ rgyl(fenc7�gctgo cot : ❑ 5.Wind Power Device
Addresr�l''/pber(nri SSttr`eet)J(^lJ1 ` (J �,, / //�1/ •/ ❑ Q 6.Hydroelectric Power Device
l-/r�(.ILI(A r`0(-CA ly I/'t} Y ! (CV to ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code / County
111 111 2.Does the buyer have a homestead in Indiana to be ❑ ig 8.1s this property a residential rental property?
vacated for this residence? If yes,provide - - ❑ Q 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)
26- 13— 12-100 -000.2_2q-00C
City,State ZIPCode County
Primary property owner contact name E-mail
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". (Note:
Spouse informatio ,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
beingaii d.) ._.s' '
Sign' ure afBuyer) 06 MANS Signature of Buyer2/Spouse
Jarrod A Keller