Homestead_Nichols INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
,D',PREFARER ...., ,� ., , ` '��H. r�._ .. ,f3 J' :, _ �-_1..-.. ,� �.,.:t:,.� >->, .r i. -�'�-. a�-��.» _ .���''S'i is ?
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 CHRISTINAeREGIONAL-LT.COM
City,State,and ZIP Code Telephone Number E-mail
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sE.°SELLERS)%GRANTOR(S] _.�� ._. ,. �`��� _..tya- `.... L.-�._- ? = r.:7:< :.., �.7:1-75177`_�x r . . .
Brad R Riker Alicia A Pieper fka Alicia A Riker
Se ler I-Name as[�a�pp�`�`s on conveyance documentix, {eller2-Name as appears on conveyance document
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E-mail
Undey/pdenalties o perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a //�FZ p/e a required by law,and is prepared in accordance with IC 6-1.1-5.5 " roperty Sales Disclosure Act".
SSigntitoreofSeller7"77 YlgnnturevfSeler"-"" /� QQ
Brad R Riker 0i� j 3;ZOf9 Alicia A Pieoer.fka Alicia A Riker R T{ 6- /3 �lll
Printed Name of Seller TSmn Dbte.[MM/UMDtn) Printed Name of Seller /J p�.Sza fDO wcv
:FrBU,YER(S)%6RAN.TEE(S)`yAPPLICAT ofsriEOR,PR'OI;ERT;YstAX4DEDUCTIONS=IDENTIF,Y,rALL`:ITEMStTHATOA'P,StiY'6s may. , 7
'Donna Jo Nichols c. '1 4.--,
X5rI-Name as appears on conveyance document Buyer 2-Name as appears on conveyance documeneLr 1 /1
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r - ( The-arid eet)? . Address(Number and Street) s///
City,State,and ZIP Code ••-trim w-,..`/., a
eephoae A'umbrr`� y E-mail Telephone Number E-mail
THE SALES ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS1 PROPERTY. DENTIFY ALL OF THOSE THAT APPLY.
rYESA4NO e,CO.YDLTidN - ,1--YTS '.. 02ZCONDIT1DN2
a❑ 1.Will this property be the buyer's primary 0 3. Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence, including county:
921 N Polk Dr ❑ Q 5.Wind Power Device
Address(Number and Street) ❑ n 6.Hydroelectric Power Device
Oakland City, I 7660 Gibson ❑ ❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP e County
❑ 2.Does the buyer have a homestead in Indiana to be El n 6.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ ❑✓ 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) (r�
City State ZIP Code ^-9~ 14 -\2 - k - OcO , 8h8_ 007
County
Primary property owner contact name E-mail
Number License/ID/Other Number