Homestead_Birch INDIANA SALES DISCLOSURE FORM SDF ID: Paget
.Deena Hendrickson Closing Services
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 closinesOregionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
Ray O. Falls Elinor R. Falls BY Ray O. Falls, his/ her AIF
Seller I-Name as appears on conveyance document Seller I-Name as appears on conveyance document
603 S Hillcrest Street 603 S Hillcrest Street
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
mate,one LIP Loge �/ \ State,and ZIP Code
Sew A74/ C -e r✓\ SAP 77i4ei
Telephone Number E-mail )))
Trlpnhnnp Numh"r F-mn,
Under penalties of perjury,1 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".
Signature of Seller Signature of Seller
Ray O. Falls Elinor R. Falls BY Ray O.Falls,his/her AIF
Printed Name of Seller Sign Dote(MM/DD/YYYY) Printed Name of Seller Sign Date(A04/DO/rv1'r)
5WO000YER(SVGRANTEE(8)r`ARPIIIGATIONiFORERROHHRTWAXIDEEDUCTIONSAIDENTIRWAMITEMS:THATAFIRBY `-
-Sandra Lynn Birch
Buyer I'Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
2510W8005 2510W800S
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648F IT .,
Telephone Number E-mail
CEP 2 7 2018
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
TES ,- NO CONDITION YES NO CONDITION /���L
[� ❑ 1.Will this property be the buyer's primary ❑ 3. Homoytea$N coUNT� "•
Y AUDITOR
residence? Provide complete address of primary ❑ RI 4.Solar Energy Heating/Cooling system
residence,including county: ❑ 0 5.Wind
Power Device
603 S Hillcrest Street
Address(Number and Street) ❑ 0 . Hydroelectric Power Device
Fort-Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
;State ZIP Code County ❑ 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9.Would you like to receive tax statements for this
vacated for this residence? If yes, provide property via e-mail?(Provide contact information
complete address of residence being vacated, below. Please see instructions for more information.
including count
OS 1 p W �pU Not available in all counties.)
Address fNutnand Street)
OY+ --iGthc vI �(Q ��(O� p bjall Sandra Lynn Birch_R) '74(it-(O _c:JO 0518 Oa p
City,State ZIP Code County Primary property owner contact name E-mail
Number License/ID/Other Number