Homestead_Sullenger (2) INDIANA SALES DISCLOSURE FORD- SDF ID: Page 2
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CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE,IN 47715 812-402-4553 CHRISTINA(au)REGIONAL-LT.COM
City,State,and ZIP Codes Telephone Number E-mail
Mt -SE : �r"^. "rt.�.i.�.teh -t_.+..'T.$ = `-51a 5,1.'[' i"', ." J`.y,K' '; -:ao_1' u;-
Nora Susan Schuble
Seller 1-Name as ppears on conveyance doc„uwtie.st Seller 2-Name as appears on conveyance document
A es-roar6umd.ee11Ls ' Address(Number and Street)
1 V Syj.L/e, -I�/ 7/5
Telephone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an complete as yquired by la -pand ',pre r. .r-din accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
• , % /
Si
-iThPafSelleri ,, //-t Signature of Seller
Nora Susan Schuble _//.�✓/�J.
Printed Name of Seller S -d an'Date.IMMlibili T{ Printed Name of Seiler Sian Date(M.M/ooryrrr)
(F!;BU,X-ERgy:GRA<\;TEE(,rAP,I;LICQTION,F,GRIP,ROP,ERT,YbTAX,I)ED.UCT,IONSODENTIFiY?riLL�'+,IT,EMS3THATAP,P,GY �K`'-��-==
Duane E. Sullenaer Jodi L. Sullenger 3
Buyer 1-Name as a rs on conveyance document
Buyer"? Nam so wears nro vevn document 102<
ressF�' er and Street) Addr r er it 1I 2, l'
, 77n. E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THISPROPERTY..IDEN'nFY'ALL OF THOSE MOAT AP `'v ID
list no7mm"-noSz. .YESI -'NO coNDITI ,\ 6bi
EL---0 1.Will thl�property be the buyer's primary 171-0 -3.Homes ad `UUN? X —
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling Systeni/ -
residence,including county: El O�
5.Wind Power Device
10217 S Quail Crossing
Address(Number and Street) ❑ 12 6.Hydroelectric Power Device
Haubstadt. IN 47639 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ oes the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Fl 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.) p
Address(Number and Street) 0 - /1- .Z/,Jou_ coot o so - t—'v
Victoria R.Dawson
City,State ZIP Code County
Primary property owner contact name E-mail
