Homestead_Emmons INDIANA SALES DISCLOSURE FORM SDFID: Paget
£IPLREeARERy.-
Deena Hendrickson Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville; IN 47715 (812)759-5555 closings(a)reeionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
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James E. Mason Janice Mason
Seller]-Name as appears on conveyance document Seller I-Name as appears on conveyance document
512 Old Patoka Road 512 Old Patoka Road
Address(Number and Street) Address(Number and Street)
Patoka, IN 47666 Patoka. IN 47666
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,and is prepared in accordance with 6-1.1-5.5," eal Property Sales Disclosure Act".
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ure ofSeller ,,,,,,,,,/// Sig tare ofSeller
J E. Mason t(/�,�1i Janice Mason 1(7Q��/
Printed Name of Seller Sign to tM/oo/YYYY) Printed Name of Seller Sign Date(MM/0o/YYYY)
liF BUYER(SIY/GRANTEE(SLAP.RE IG ATIONiEORIP.RORERTiY&TAXEDEDIJMONS IDENTIEY3A L91TEMS12THAVAP.P.bYK
Anthony J. Emmons
Buyer I-Name as appears on conveyance document Buyer 2-Name as appea on conveyance document
9899 State Route 250 9899 State Ro e 250
Address(Number and Street) Address(Number a-,Street)
Lawrenceville, IL 62439 Lawrence Ile, IL 62439
PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
ly ❑ 1.Will this property be the buyer's primary 1 El 3. Homestead
residence? Provide complete address of primary ❑ p 4.Solar Energy Hea- -g/•9+oling/Syst?
residence,including county: ❑
512 S Old Patoka Rd 0 S.Wind Power Device AU.G 1 3 2018
Address(Number and Street) ❑ O 6. Hydroelectric Power Device
Patdka, IN 47666 Gibson ❑ �.Geothermal Energy He {TTi�ng/Coolin evice
City,State Zl Cade County 'Uh- ' ?
❑ 8. Is this property a resiO00000111111ttttttiiiilllltl l+nla operrtty
❑ 2.Does the buyer have a homestead in Indiana to be ❑ El 9.Would you 1. GIBSOcervCOax COUNTY llOrR. is
vacated for this residence? If yes,provide
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) Anthony J. Emmons-