Homestead_Barney _AINDIANA SALES DISCLOSURE FORM SDF ID: Page2
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Jennifer Wade Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Member and&reel) Company
Evansville,IN 47715 (812)759-5555 closings@rezionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
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Ronnie H.Summers
• Seller 1-Name as appears on conveyance document Seller 1-Name ar appears on conveyance document
• 3370 W Selciu Ct
•
Address(Number and Street) Address(Number and Street)
Bloomington,IN 47404
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".
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Signature of Seller ' i C 7i tin laid Signature of Seller
Ronnie FL Summers, By Jeffrey H Summers,his Attotney-in-Fact
Printed Name of Seller Sign'knew:gm:wry* Printed Name effect- Sign Dote On4/10DAYY13
intragr SITORMTEE 1 gr.—anti-6 AT iliNikAili-fkIPTETSTAXibEDU G-tioinERMIMINTEM—S Z i C.: 4: -"4.---t--:7:MT-- -
' Jade W.Barney,S
le, • -:—• .
'Niltpr.1-14umes appears on con7nce docurt Buyer 2-Name as appears on amveyonee drat. ' 2 2 . Et
te-zur3r
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Mar= ma.saseti 771- 11t7
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Y NO CONDMON
ES i YES NO CONDMON
0 lr-Will:tliath—ethe buyer's primary Lf1 0 3.Homestead
residence? Provide complete address of primary LI El 4.So ar Energy Heating/Cooling System
•
residence,including county:
0 El 5.Wind Power Device
228 W Monroe Street
Address(Number and Street) 0 121 6.Hydroelectric Power Device
E I/2;4
Princeton, .7670 Gibson 0 El /7.Geothermal Energy Heating/Cooling Device
Oty,Stab alP County 0
R" 8.Is this property a residential rental property?
0 2.Does the buyer have a homestead in Indiana to be
0 PI 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide
complete address of residence being vacated, property via e-mail?(Provide contact information
. below.Please see instructions for more information.
including county:
Not available in all counties)
• 2-6-12_-•31-SOLI --o0 D. 353-02E'
Addren(Nuraberand Street)
Jade.W.Barney •
C14;State ZIP Code COW*: Primary property owner contactname E-mail