Homestead_Dunning INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
;D..PREPARER ss JI' '--i -. n._'-._ . !. :i . ._ ,' frr3 _ .-/.:. -- : . : ,Lbt-
Dana Belcher Processor
Preparer oftbe Sales Disclosure Form Title
2301 N. Burichardt Road First Advantage Title
Address(Number and Street) Company
Evansville. IN 47715 (
E-mail
EiiSELLER(SyGRANficol) `7:-m .71 mra 4S2°-1.F 4yci,. :'9..f`a'ri _f�.'t.:'.tii tJ:'+>4. . 1 Y: '3i;4.734
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Chaz Michael Kenworthy
Seller 1-Name asCol.
appears on conveyance document Seller 2-Name as appears on conveyance document
/cqS V l.. CA A.P.n t/.-t Q c-c)
ddress(Number and Street) Address(Number and Street)
E-mail Telephone Number E-mail
Under penalties of perjmy, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is tare,correct
ant)complete as required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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Signature Seller Signature of Seller
Chaz_Ni
It 5(❑ZOIf1
n[ed NameofSeller Sian Date(.N,v/DDAITY) Printed Name of Seller 'q MM/DD/YYYYJ
�F::BUYER(S)%6k-A TEE-VAPP,L'IGATION_+ , `, UPEkIWcticA4-b.0CTIONS``5IDENTIFYALtaXE T AA, APP ,+ `
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Stephanie A Dunning
Buyer] Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
LIDS F 71rt1i( P A i ( D( MAY 8 2019
Address(Number and Street) , dress(Number and Street)
Fti( i 6(ana --0,1 41ELI
City.State,and ZIP Code _ C •,Slate,and ZIP Code
( GIBSON COUNTY AU TOR
leohone Number E-mail Telephone Number E-mail
THE SAL SURE FORM MAY BE USED TO APPLY FOR CERT IONS FOR TH TAPPLY.
YE NO CONDITION 1' NO CONDITION
Li I.Will this property be the buyer's primary I ❑ 3. Homestead
residence? Provide complete address of primary 4.Solar Energy Heating/Cooling System
residence, including county:
.40 G D )_ T(e+4 e 1 Pel 1 r t7( ID ID 5.Wind Power Device
Address(Number and Sneer) ❑ Q 6.Hydroelectric Power Device
FOt+;z1, I1flC r ,I 41(,L( s Ol�SbYI • ❑ ❑ 7. Geothermal Energy Heating/Cooling Device
City;StCode County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ ❑� 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Z 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: e see instructions or orrnation.
Not available in all counties.)
Address(Number and Street) /�,
City,State ZlP Code lour, • 2,• ,- 19- I g 3O2___• .5� • (0��
Pm), tv owner contact name E�erl1
Number License/ID/Other Number