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1 ° O _.,‘ES DISCLOSURE FORM SDF ID:
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iar - -am Hancock
title administrator/closer,t,�N_V PreparerT
ofthe Sales Disclosure Form Title - -'--
Hs 221 NW Fifth St Lockyear Title, LLC
Address(Number and Street) Company
Evansville, IN 47708
_E SECLER(S)(GRANTDR(SH '.: ` ^HI':—H. -._:>: _HHHH HHrHH i;r -- ,- 3. - 3-- a
Kimberly A. Keegan, Individually Genevieve Beloat by Kimberly A. Keegan,Attorney-in-fact
tierl-Name as authors on convey nee 9 u�nt Seller 2.Name as appears on conveyance document
g.5 ',ltfiCA l (1(V1Kt-
ess(N'umbera trees) Address(Number and Street)
W nS1/frf' //V 1I 77
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
and mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5," ea)Property Sales Disclosure Act
cmboil )q- L3i i 6enaalive OW OA;bo /u A. k fr
Signature ofSeller� Signature of Seller // ' %
Kimberly A. Keegan, Individually )/ �j//�1 Genevieve Beloat by Kimberly A. Keegan, yS_//3 f
Printed Name of Seller Sian Dash(NH/DD/YYYF) Printed Name of Seller Sian Dale�1/00A Trtl
•F.BUY R(S).i[G&ALHTEE S -APPLICATION,F,OR P,ROPERTY-TAX DEDUCTIONSHDENTIE ALL ITEMS,THAT APPLY_ _—
Jennifer C. Simms
,, on canvey,ante document Buyer 2-Name as appears on cony a au nt
521 S 8th Avenue
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 MAY 13 2019
E-mad Telephone Number Wig.
E-mail
THE SALESDISCLOSURE FORM MAY BE USED TO APPLY FORCERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF�sfalftklg. IY AUDITOR
YES NO CONDITION YES HO CONDITION
❑✓ ❑ 1.Will this property be the buyer's primary H 0 3.Homestead
residence? Provide complete address of primary eating/Cooling System
residence,including county:
521 S 8th Avenue ❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Evansville, IN 47725 Gibson ❑ D 7.Geothermal Energy Heating/CoolingDevice
City.State ZIP Code County
pH 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 ❑ D 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
— 6 0r including county: / below. Please see instructions for more information.
G /j$cM1t tied- Not available in all-counties.)
feldress,(5mcf.umper Ireetv l 7t39 6C -o
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City State ZIP Code County /V\ L/Oq
Primary property owner contact name
E-mail
Number License/ID/Other Number