Homestead_Bajzath INDIANA SALES DISCLOSURE FORM SDF ID: • Page 2
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Lana Harper Closer -
Preparer of the Sales Disclosure Form Title
5231 Oak Grove Road Ste A Total Title Services, LLC
Address(Number and Street) Company
Evansville,Indiana 47715 1-812-468-8485
City.State,and ZIP Code Telephone Number E-mail
ESEIitiER(Sj/GRANTOR(S) -- - �-� _ - --- ' `
Shaila D Rawlinznn n/kla Shaila Rheeling
Seller I-Name as appears on conveyance document • Seller 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
Prsnctror�J'! Y 7(i017b
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-L1-5.S,"Real Property Sales Disclosure Act",
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Signature of Seller Q '/ (�/ Signature of Seller
Shaila D Rawlinson n/k/a Shaila Rheeling ( 'UP—1.R
Printed Name of Seller Sian tote 1MM/DD/YYYYI Printed Name of Seller -1 to(MM/DWITYY1
;E:BUYER(S)%GR NNTEE(S),ARP,LIGATION,$ORPROP.ERTA TAX DEDUC-TIONS=IDENTIEi;AL12 M lA P. q L + -' ,-
II ton R. Baizath
8u `i-u.,r;...,r rs l�ryatlse cement Buyer 2-Name as appears on convryant43eTise1. 20/8
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�A,tfQr/J es um .and Street)/ / q' Addres(Number and Street)
City,State,and ZIP :1, N Ciry.Smfq and ZlPCode GIBBON COUNTY AUDITOR
Telephone Number E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION • MON
0 ❑ 1.Will this property be the buyer's primary 0 D 3.Homestea
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
esitlencctudin county:
1 [iJ9 jj ,LL (�/DPe ❑ ❑✓ S.Wind Power Device •
ce
I r'r Pp_vt, 7A( 4 74/l S ❑ 0 7.Hydroelectric
eoth e coal Power ea
(J n ❑ 7.Geothermal Energy Heating/Cooling Device
Ciry.Stgter'JP Cade County
❑ Ij�af�,l 2.Does the buyer have a homestead in Indiana to be ❑ ❑ 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)
a6 -- DY-o2S -102 - 000. ,he '1-0 -O
City,State ZIP Code County
Primary property owner contact name 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 IC 6-1.1-5.5,"Real Property Sales Disclosure Act";(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bein Oled.) -
Signature of Buyer! /) rs i �a> Signature of Buyer2/Spouse
C'.oltnn R Bajzath Y �//VJ_ -