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Homestead_Gengelbach • INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D:P,REPARER'..:e.a. fa °a a s t° :4Teft:7? 0 '+ " e53 e•..s 1£ ;t tv sY 'ic' Jeff Dodson Closing Agent Preparer of the Sales Disclosure Form Title 1911 Lincoln Ave Clear Title Company Address(Number and Street) Company Evansville, IN 47714 812-423-8854 City,State,and ZIP Code Telephone Number E-mail t E.T SEL S /GRt A N TOR(S + +- - < .n �r..�C..ts' n 3eg �..5. _ a - Lsi-ra._,.,5.. Rawi" r="}"v . kalt:77_17 xrP Kenneth S Gullicksnn Seller 1-5<4 Leas are, conveyance docu pant r Seller 2-Name as appears on conveyance document Ad s(Number a///4l suttee[) K<'tl Address(Number and Street) • onVI Ie / SA I-/76G 1 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 and complete as required by law,a is repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". /red a Signature of Seller Signature of Seller -'Kc/li -Hi K (1u//1ilC 011 t P/3 /r Printed Name of Seller Sian Date(14M/D0 r rv) Printed Name of Seller Shin Date(MM/DD/YYY1) (1$FBUYIER(SW,GRA'NTEE(S)LEAP,REIGA•T,IONfF,ORVRROP6RTeY4A•X•DEDUCiTiIONStIDENTIFeVAL+IND 1 •TlifirA811G'Y1_ '' =' .rw 2 Kevin L. Gen�lbach ceneet 6"`'11 , Jennafer L• Geri�lbach G ,�Cl , 1 Buyer I-Name lb)S appears on conveyance document BuyerT-Name as appears on conveyance document 704 Laurel Ridge Court 704 Laurel Ridge Court •A•��I Ir 1 0 2016 Address(Number and Street) Address(Number and Street) Haubstadt. IN 47369 Haubstadt. IN 47369 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 0 5.Wind Power Device 7041 anrel Ridge Court Address(Number and Street) ❑ 0 6. Hydroelectric Power Device Haubstadt, IN 47369 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be El 0 8. Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 0 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) (�'�(1 1 City,State ZIP Code County V`�-•�_ 31_�� ^��D .���^�� Primary property owner contact name E-mail