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INDIANA SALES DISCLOSURE FORM SDFID: Paget
D.PREPARER
I
CHRISTINA LENFERS CLOSING AGENT
Prepares of the kit Disclosure Form Thee
• 501 MAIN ST STE 101 BOSSE TITLE CO
Address(Number and Street) Company
EVANSVILLE IN 47708 812.421-4000
City,State,and VP Code Telephone Number
I Ph° I Email
I
I
E.SELLER(S)/GRANTOR(S)
BFNJAMIN L HOFFHFRR MEGAN R HOFFHFRR
Seller 1.harm as appears on conveyance data. t Seller 2-Name as appears an conveyance document
F�� fI?Lna � SAME
umber—t Street) I I • Addms(Number and Street)
a Jr-1 CysVI IWC EC ��as I
a
ay.Stataand 7JPCode
lcoPhone Number Email. Telephone Number Email
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".
1 -- t.�Q,ln 3 1- -1/i
("Signature Sells nature o/Sei ir
RFN.IAMIN I HOFFHFRR 03/12001 q MEGAN B HOFFHERR 03/12/7019
Printed Name Seler Sian Date(YH/OU/YYYII Printed Namen(5eller Sign Date(NM/0D/rrrr)
F.B /GRANTEE(ST-AReLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
GAVIN T.GRUSZEWSKI
Buyer l-Name as appears on con mast Buyer Name as uy appears on conveyance document
1746 E WARRENTON RD
Address(Number and Street) Addrm(Number and Street)
HAUBSTADTIN 47639
City,State,and AP Code My,State,and ZIP Code
Email Telephone Number Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TIILS PA On rum APPLY. ��
YES NO CONDmON YES NO CONDITION
[r 0 1.Will this property be the buyer's primary Q---❑ 3.Hom GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary , oar Energy Heating/Cooling System
residence,lnSttiingcounty:
505 E &-i ❑ a 5.Wind Power Device
A dr (Na ar So- .13u 'tick? 6(bSet ❑ a 6. Hydroelectric Power Device
G ' 0 a 7.Geothermal Energy Heating/Cooling Device
dry,State ZIP Code County
0 [/2.Does the buyer have a homestead in Indiana to be 0 My B.Is this property a residential rental property?
vacated for this residence? Ifyes,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
including county: be a see ins c re information.
Not available in all counties)
Address(Number and Street) 6-19-31-300-000 . 334-009
City,State 2IP Code County
mary property owner contact name Email
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