Homestead_Lindauer (2) INDIANA SALES DISCLOSURE FORM SDFID: Page 2
D?PREPARER`=-- -
Timothy Shea 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 n reoionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
L.r, a �_. � � a - �)'... -�_. _.. ,—jz a 3'F� ..>� •. �.,._ _ .. t_F-. .... a- t , � :.'4a
Douglas P.Adams Lori L.Adams
Seller I-Name as appears on conveyance document Seller I-Name as appears on conveyance document
522 W SR 68 522 W SR 68
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 Haubstadt, IN 47639
}rate,one LIP lode state,and Lip Code
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 wi C 6-1.1- 5,"Real Property Sales Disclosure Act".
_
Signature of Seller Signature of Seller
Douglas P. Adams lyo'f 8 Lori L. Adams -(I '�I(8
Printed.NameofSeller gn Date(MM/DU/ Y) Printed Name of Seller Sign Date(MM/DD/YYYY)
U.BUMERI RTA,\4TiEE(5 VERLICATIONCEORt8ROBERTiY6TAXiDEDUC$iIONS IDENTIF.Y6VINITEMSISFiHAT.ARRIlla-•1 -
Adam M. Lindauer
Buyer I-Name as conveyance document Buyer 2-Name as appea doe
1743- ate Road 168
Address(Number and Street) Address(Number and Stree �tf"E,d- _JD
Fort Branch,IN 47648-8539
Telephone umber---____ E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTI&Y A'P gitb ,@rvp ITOR
' YES NO CONDITION / YES NO CONDITION
.\
J ❑ 1.Will this property be the buyer's primary YES NO
❑ 3.Homestead
residence? Provide complete address of primary p 4.Solar Energy-Heating/Cooling System
residence,including county: ❑
522 W State Road 68 2 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ E 7.Geothermal Energy Heating/Cooling Device
City,Sta e�IPCode County El 8. Is this property a residential rental property?
❑ 'I ] 2.Does the buyer have a homestead in Indiana to be ❑ 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.
�G Not available in all counties.)I -.T{-�� --�y"�s
Address(Number and Street) 1'G - 2-2- -0 [-20Z - 000 Lk I ` vc' '
Adam M. Lindauer '
City State ZIP Code County Primary property owner contact name E-mail
Number License/ID/Other Number