Homestead_Bolton (2) .0IANA SALES DISCLOSURE FORM
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CHRISTINA LATHAM TITLE CLERK
Preparer of the Sales Disclosure Form.
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4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Nu er and Street) Company
EVANSVILLE.IN 47715 •
812-402-4553 CHRISTINA➢(WREGIONAL-LT.COM
City,Slate,and ZIP Code Telej,bon`e Number
E-mail
E.SELLER(S)/GRANTOR(Sl -
Daniel A G➢edde
Seller l-Name as appears on conveyance document Seller 2-Name as a rs on cony
v Z O� d-ro o $Sm
Ad PPS emrtcc document
/dress(Number and Street)
X -F� area
E-mail Telephone Number
E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my Imowledge and belief,is true,correct
and co I s require by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
tare of Se t - Signature of Seller
aniel A.(',nedde •
et-6 -/q
Printed Name o Seller Si n Date NU Do. Printed Name Seller
Si nOcte uH aL
Illantk094 .r AP fDKACPIOI FOR1111 E;ER!IT tkib6 UNIONS-i41ll f'♦rTiPtlCrill,Tirtiti S 17Fl0rAPMY:a.. " ilt
Cheryl L. Bolton
XEvyet-1:Namearappearsonronveynnar �nej( ( /G .... Buyer 2-Name vsapyrunonconveyancedocument
W77 E F.„, 1�f�G{1 FILED
Add ysaber a Street) ..,� / Address(Number and Street)
T ' �l(tQru —1-?V t'7kW Feb 082019
Llty,
5-mail Telephone Number i _
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR amity DEDUCTIONS FOR TIIIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION - I YES NO CONDITION
❑✓ ❑ 1.Will this property be the buyer's primary ❑✓ ❑ 3.Homestead
residence? Provide complete address of primary
residence,including county: ❑ ill 4-Solar Energy Heating/Cooling System
406 E.Strain heat Ft Branch IN.47648-1421 ElI❑�I S.Wind Power Device
Address(Number and Street) - - ❑ i l 6. Ilydroelectric Power Device
GIBBON ❑ ❑✓ 7.Geothermal Energy Healing/Cooling Device
City,State LIPCode County
❑ El2.Does the buyer have a homestead in Indiana to be ❑ n 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ ❑✓ 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via a-mail7(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) 26-19-18-303-000 . 371-026
ary,.uateZIP Code Cheryl L.Bolton
County
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
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note:
Number License/ID/Other Number