Homestead_Martin (9) INDIANA SALES DISCLOSURE FORM `_ SDF ID: Page 2
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D}P� EPARERI _ — —
Kandace Rogers Closer
Preparer of the Sales Disclosure Form Title
1 3101 N. Green River Road Suite 130 Columbia Title
Address(Number and Street) Company
Evansville, IN 47715 812-471-8563 kandacetohcolumbiatitlegrouo.com
City,State,and ZIP Code Telephone Number E-mail
?ESELLER(S GRA�TQR�S])
Roth A Stevens
SellerVarye lsoppmn on m e docum /1 -J Seller 2-Name as appears on conveyance document
ll, ``//''��II. II`(//, / (^Jrrsll 1 (ht//y(l •
Adrrets( nber an StreiH I N , I 7 /�� Address(Number and Street)
11 11rrll II ( t1l /l/I(,�)
Ciry;State,and ZIP Code City,State,and ZIP Code
E-mail Telephone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an om to as rgquir,,nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature ofSeller Signature of Seller
Roth A Stevens 12 •;-1_I
Printed Name ef Seller Sign Date(MM/➢D/YYY11 Printed Name of Seller I:to(1414/Dn/YY39)
LF BE '_ YITEE(S]j_AP.P.L`ICATIONiFQR:PROPE$)Td'7TA;\iDED11CTLI0NS_IQE\'TIFI A14,11 ti7 : 1
Matthew K Martin nn AI�,, 2
Buyer I-Name as appears o onveyance document Buyer 2 Name as appears on conveyance&) APlt 2019
bbu West 0 d Princeton Rd
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665 `l•s`t„v,
City,State,and ZIP Code City,State,and ZIP Code GIBSON GUUN I Y AUUI I OR
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
O ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ ❑✓ 4 Solar r ring/Cooling System
residence,including county:
5660 West Old Princeton Rd U Ill 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 R. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax statements for this
complete address of residence being vacated, ro ' 'ia e-mail?(Provide contact information
including county: below.Please see ins ' is or more information.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code Coon -11 31 -400 —Dos - 141 21 .
Primary property owner contact name E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
Number License/ID/Other Number