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Homestead_Jacobs _. -., ...•-,... • , . . . • . . . .. Deena Hendrickson • Closing Services ' • Pieparei of the Sales Discloitiri Form Tide 7820 Eagle Crest Blvd Ste 201 Regional Title Services Address(Number op zd Street) Company . : EganS ville;IN 47715 (812)759-5555 , closinas@rezionaltitlellcom - City,State and ZIP Code ; Telephone Number • , • ' • ... .Email .. - .., 'Miiilrecv-S:ViEkiii-1:*7—7 r-r—;''—'7. ---77-?-7,:ri .——17--; .--- -'77--717277-2 ,.. , '',s icr—r--77- - -..- . . ( -'----• - ;7 feller I:Nonida-sinsiors on ednv-eystriee document - ' :: " "- - Seller 4:ycliiiiiilinialif. Coiteye-nei doFeihent: — -- - - - -- - ----; 2567 Warrenton Road 2567 Warran-6• .."8-ad nrldiers(Nim her and Stria) Address(Num, and Street) -.- . Halliatikle,1-14 47639 Haubs .: ;IN 47639 , . ?) ,-..{: . ,-) - - T elione Number ' -, --. • • •-- 5-mail ,- Under penalties of perjury I hereby certify that this Sales Disclosure,to the best of my knowledge and belief is true correct - and coin e as required bylaw,and is prepared in accordance with IC 6,1.1,5.5, Real" Property Sales Disclosure Ace. . .. . .., ..,.. — , -.---___- . . . .. . Signature of Seller . • / MatthewlS. .ielcWs . •--1010120/X.•-• • s • ',:.:•' : -; • . - - Printed Nero/Selter--- ' ":77- :"-• --:- toff te(1414/1911/YMI--;- 7 Printed Naini-of Segel-.---- 777----- -7-----:-;-----7-Sign Date(WIIDWYMI-7 : :: 71•:::::C..,: ::::%in:, ::.2....'- :141:::: :it'(::: : -.:IN: ::1!::::!::: :::::: ‘... : ii: i :::: 1: II:i ii: rl'::::1::• e.:: . ":”.7;r,..;aver •...fm!:i . Klifferini J:Jaabi-::; :--"--.— ----- 7-:--T :7.7:7-t•- ''. -.- '* 7'7-.'75-771-7-7-r/Fr,"7,j: 7.77- •-_777777. -z71 .-- •y-2- BY*1---Nameis atiPtirt:rsjulaNliiialliithit-intini- ----.-----,':--7----- -. Elet;er' ?7 Nita ks-a-FT•'Ian fon-Cey-aiiii dearni-etirr 7--c---- 7:------- -7--I. •:17851 Nwy41 N . . 17851 Hwy`, N Addnms(Number and Street) - Mayes,(Num.-• ,nt I Wrest) y-7--r--,- ,- • . - .- * Evansville, IN-47725 Eyarisvi •:IN 47725 :, , - • • • .. .•_ . . .1..: ...* . t•,•11::- ' • ,.-... THE SALES ISCL-OSU.4101;131:1YBE USED TO APPLYFONTCERTAINDEDUCTTONS F011THISPROPERTIT.FitfTIFYALFOFTHOSE THA--; 41. ,, 1 ---;-;-.--------Mc5- - :-...' ''' ''''' .. '' -:. '. ' ' '' : :/•;1.1 I.: '.- set-# -?- GIBSON COUNTY AUDITOR • F I YES - NO • CONDITION YES 4 NO • CONDITION I•• ...• •.• • • • - • - pp 10 1 Will this property be the buyers primary El 3. Homestead • ' - _ , residence' Provide CoMpletiaddreii of primary 0 M 4.Solar Energy Heating/Cooling System .• ..': residence,including county: •-:: : 7- ... 0 IZI S.WiMi Power Device . .' 2567 Warrenton Road . - . . ' 0 • ei . .H y 0 r o c I e c t r i c Power Device . HaubStadt, IN 47639 Gibson 0 0 7;Geothermal Energy Heating/Cooling Device City,S W ZIP Code- - -7-- ” " -— - ':-1:7,t .:- 7- - canna: 0 8:Is this property a residential rental property' I. .. n 2.Does the buyer have a homestead in Indiana to be - • 0 El 9.Would you like to receive tax statements' for thi - s vacated for this residence? If yes,provide • - • -• - • property yia e-mail?(Provide contact information . complete address of residence- being vacated, , _ . . , below. Please see inetructions for more infoi-mation. , including county: . s Not available in all counties.) ' . . • Address(Number and Street) . 7;'77- 7-- 7 - ,t-Q163.1LiatAirc IS-13-.C5E5 -0.10:1 ..5"OS-0029 . .Katherine .Jacobs ' -.. :;• ' . . • ., .: ? ..- . . -- i : -1- A "-my:State ZIP Code : --:: : -- - ---''77 T-:'-----County- Primo-mr-7-tip property owner —7 '----- —7--;"---7--.--i;:iii-' - . ,. Number License/ID/Other Number '- , - - ., • - 4. .-,