Homestead_Koch INDIANA SALES DISCLOSURE FORM .SDFID: Paget
ELP.REPFARER - . .. .
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 closines(tilregionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
Mark P.Thomson Lisa G. Smith
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
/6)6 ?3 C .7C) NI r /0 6 93 -. S�) Al
A_• dd (H random �� Address(NumberandStreet)
1/f (V/5/,1 j .7 2, -,n /-/7 4'& )
.., of Ar Goode,
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Under •enalties o .erjury, hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and 'mple a uire•_. aw,and is prepared in accordance with ICC66-14.5..5,""Real Property Sales Disclosure Act".
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(LUlan. reofSeger �� /nn Signature of Seller // �j�/q
ark'P.Thomson l///��/Lr/� Lisa:G. Smith L] �//11/!(iJ()
Printed Name of Seller Sig Date( M/DD/YYYY) Printed Name of Seller Sign to(M l/DD/YYYY)
P BUYER(Sl'/GRANTEE(S)JAP.P.L^ICATIONIEOR2P.ROP.ERTYsTAXIDEDUCfIONS-IIDENTIEY.r\BLtI:TEMSSTHATIAP.PUYI _.-1
Karl G. Koch Kelly Rae Koch
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
515 Wind Circle 515 Wind Circle
Address(Number and Street) Address(Number and street)
Evansville, IN 47711 Evansville, IN 47711
FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TH. .PPP).• !F'�
YES / NO CONDITION YES NO CONDITION 111777JJJ
Se, IQ 1.Will this property be the buyer's primary ❑ 3.Homestead DEC 4 2018
residence? Provide complete address of primary ❑ a 4.Solar Energy Heating/Cooling System
residence,including county: 0 5.Wind Power Devic �!
10693 E 50 N ❑ e;U6le j4+
Address(Number and Street) ❑ 0 6.Hydroelectr'kg({t vgp Dsnig ;Ty AUDITOR
Oakland City, IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,S to ZIP Code County
❑ 8.Is this property a residential rental property?
�❑ 2. Does the buyer have a homestead in Indiana to be
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
ncluding ounty: ` below. Please see instructions for more information.
i615 In)I nJ I) Li RC LE J ` Not available in all counties.)
Address(Number and Street)&VANS\[(Li 6 i �1.l .. �I.771j Alq tiritiaAg6iiab -l3'1.2- /ou-w . 9qq-0o4
City State ZIP Cade / County Primary property owner contact name E-mail
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