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INDIANA SALES DISCLOSURE FORM SDF ID:
Page
22D'PREPARERS— -a(areaz 12Sqa ' p"P'i :. - Y - r
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KRISTIN WELLMAN PURCHASE TEAM LEADER _
Prepare(of the Soles Disclosure Form Title
4501 CHARLOTTE PARK DRIVE, SUITE 120 AMERICAN HOME TITLE
Address(h'unjber and Street) Company
CHARLOTTE, NC 28217
aESEISSI/GRkNTOH(SjW_ i"-25 a" cI'i .'" silt '
filaajnaiLW
IAN M FREDERICKSON
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
7177 OUTER I INCOLN AVE APT 3G
Address(Number and Street) Address(Number and Street)
NEWBURGH'IN 47630
City,State and ZIP Code • City.State,and ZIP Code
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
and c lete as uired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of '/ Signature of Seller
IAN M FREDERICKSON e/// /9
Printed Name of Seller Stan to APP,C MN/OD/)YYn Printed Name a Seller Si.n Date(MM(DO
t
2LEELnO0f .. 'J Urr +t a •- :. •,,, , e i.-
ROBERT A. HAI L II
er - nce document Ruyer Name asa ye appears on conveyance document
2011 N.VANBUREN STREET _
Address(Number and Street) Address(Number and Street)
HUNTINGBURG, IN 47542
City,State,and ZIP Code City,State,and ZIP Code F I LED
Telephone Number Apr 1210.19 E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPER o , ---- •-. . I. ,SE THAT APPLY. .
YES NO CONDITION NO 'CONDITION
.I21, 0 1.Will this property be the buyer's primary Ej. 0 3.Homestead IBSON COUNTY AUDITOR CB
residence? Provide complete address of prima , iiiIIill2 •, oar nergy 'eating/Cooling System
residence,including county:
❑ W 5.Wind 'ower Device
Address(Number and Street) 0 Vi 6.Hydroelectric Power Device
❑ a7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ( 2.Does the buyer have a homestead in Indiana to he , 0 B.Is this property a residential rental property?
vacated for this residence? If yes,provide 0 0 9.Would you like to receive tax statements for this
complete address of residence being vacated, ovide contact information
including county: below.Please see instructions ore information.
Not available in all counties.)
Address(Number and Street)
26-14-19-101-000 .005-007 .
—
City,State ZIP Cade unty,
Primary properly nv mnrrrt name /f-moll
Under penalties of perjury,)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:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
tieing filed.) , „ -