Homestead_Duffy INDIANASALES DISCLOSURE FORM SDFID: Paget
t Stacy Brown 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 - closings(uDreeionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
Brianna(Ward)Chavis
Sfr\-fame ps gppear n�iveynnce document Seller 1-Name as appears on conveyance document
Mirecs( mllbeeerVII S�trJeeet) K S_(L 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
4t complete as re i ed by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
61
Signatures of Seller Signature of Seller
Brianna(Ward)Chavis 1112011
Printed Name of Seller Sign Efate(Mrs/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
I3OTER(SWG-1 431EE fSIKARBLI CATION)EORkP.ROBERifiYLTAXWE DUGTIONSJI DE NT1 E.KAIIILITEM SLTHATLA'P.PLY•
Doris L. Duffy
Buyer](Name os ap n conveyance document Buyer 2(Name as appears oncanveyorrKdgrr�rtp-
Address Number and Street)
Address Number and Street) gy�5, Inl�f
ED
Salem, IN 47167
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THISeROPERTY. IDENTIFY ALL OF 7t 6 ;'N-fY AUDITOR
eYE NO CONDITION 7 Y�ES,/ NO CONDITION
Le❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary oling System
residence,including county: ❑
514 V Polk Street M 5.Wind Power Device
Address(Number and Street) ❑ El 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ 21 7.Geothermal Energy Heating/Cooling Device
CitytoteZIPCode County Ela 8.Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ a 9.Would you like to receive tax statement 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.
810 N Main St. ((�� r Not available in all counties.)
SalAddrem, IN r and S Idel5kiIflY -11 -12- 1a-4ot^tUoo .�'-_oa
Salem, IN 47167 I ab l Il 'U b
City,State ZIP Code L Coubty, Primary property owner contact name • E-mail