Homestead_Coomer (11) INDIANASALES DISCLOSURE FORM SDF ID: Panel
dDS,PREPARERC rS .�:,..�� a = Lt'. �."a. l • v .'za r mot3"5 a; s2 -t may7 :
Jennifer Wade Closer
Preparer of the Sales Disclosure Form Title
7820 Eaale Crest Blvd Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 (812)759-5555 closines(nlreeionaltitlellcmn
City,State,and ZIP Code Telephone Number E-mail
t•tif:Z t,4'.. xd`�r'� t- -3 '��rd eeab7r4�°C �_ _ ,W--j3ps�•- - �" w �� uFs .'r4
Lance R. Davis
Seller I-Name as appears on conveyance document Seller)-Name as appears on conveyance document
2068 E SR 64
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
Telephone Number E-mail
Under penalties of perjury • eby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and
(coom/ te asd �
requ e .w,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature ofSel". er -ro:cz' / / Signature of Seller
Lance R. Davis /19/0/J �l 8/
Printed Name of Seller Sig(,Date/MM/DD/YYYY) Printed Nome af Seller Sign Date(MM/DO/YVYY)
LF';BUY,ER(Sjti/GRANTEE(S 0+AP,P CATIONYO—iifRROPER'TYLTAX Hbi TION5=iffirfr iNALL4ITE6'1gai-17 gARP,LY�f- 3� a;J
Cara Coomer
Buyerl-Name as appears on conveyance document Buyer 2-Name as appears an conveyance document
West
Address
(Numberand
Street) Address(Number and Streetggg gEDOwensville, IN 47665
YES NO CONDITION TY AUDITOR
❑ 1.Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑
2068 E SR 64 0 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ 0 .Geothermal Energy Heating/Cooling Device
City State ZIPceton a County ❑ B. 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
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) Cara Coomer alt-194b 101- 000. qa7^ ba`1
City,State ZIP Code County Primary property owner contact name E-mail
License/ID/Other Number