Homestead_Holder 1 ,
INDIANASALPS DISCLOSURE FORM SDF ID: Paget
YDxPREPARERC ` _ F :win} =^ar,:_''' t4,-Pea `s: a :;t vt :n.;rc'Fyi4 7e:V. .'F .. r Y ;= r,1c C �_;,''. -s 9 ' j
Stacy Brown Closing Services
Preparer of the Soles Disclosure Form _Title
7820 Eaele Crest Blvd Ste 201 Regional Title Services - ... + -- -'— =--"`='' ----` '
Address(,Number and.Street) Company
Evansville, IN 47715 (812)759-5555 closines(olreeionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
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Mary A. Hisch —
Seller 1-Name as appears on conveyance document Seller I-Name as appears on conveyance document
•
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Address(Number and Street) Address(Number and Street) - ---
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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Signal eofS ler /fy�� r7lit Signature of Seller
Mary Hi ch O'I l Printed Name of Seller Sign Da (AIM/D l/YYn) Printed Name of Seller Sign Datet.[M/DDmYn
5:BUYER(S)'/GRANTEEfSI AP.P.L GATtIDNIEORtRROPffilt aTAXaDBDUt4IONSI-LIDENTIEY-AIi.L 1TFMScTiHt1T APPL rr : 1
Grant A. Holder
Buyer 1-Name as appears on conveyance document Buyer 2-Name os appears an conveyance document •
205 West Vine Street
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 SEP 25 2018
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THE SALES DISCLOSURE FORM MAY DE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES 0 CONDITION
LI 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling System
residence,including county: ❑
1037 \V 1200 S El 5.Wind Power Device
Address(Number and Sweet) ❑ 5 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ 12 7. Geothermal Energy Heating/Cooling Device
City,State ZIP e County ❑ EV8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to he
vacated for this residence? Ifyes,provide ❑ 5 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
ncluding county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
DU) a- V- — IcO - 00I . L23131-oaf
City,State ZIP Code County Primary properly owner contact name E-mail