Homestead_Shaw II INDIANA SALES DISCLOSURE FORM SDP ID: Paget
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3P,.REPARER. �.��. � .� .�:;.,...z. _�_f:.�.� ,.__ _ •.fit:;._.. -.-�i,��.
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Tiffany Moon Closer
Preparer of the Sales Disclosure Form - Tide
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street) - Company
Evansville,IN 47715 (
City,State and ZIP Code Telephone Number E-mail
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Patsy L.Cloin '
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
6808 Clubhouse Dr,Apt.C C
Address(Number and Street) Address(Number and Street)
Harrisburg,PA 17111
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6-mall 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 plete 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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A Signature of ier 2/ 7 ' Signature of Seller '
Patsy L.Cloth D5/2�//�//9
Printed Nemec Seller Sign Do (MM D/YYYY) Printed Name al Seller Sign Date(MM/DD/YYYY)
r•BUYER(Sl'/GRANTEE `I AAPLIICA' IONROR.p.ROPERTI'TAXtEDJETTONSIDENTIFY'AI:MI.TEMS-.THA1'API elLFD
Charles E. Shaw II Brenda K. Shaw
Buyer I-Name as appears on co: •nee document Buyer 2•Name as appears on conveyance document May 28 2019
• - ••• :ne 439E Hirsch Woods Lane i[_
Address(Number and Street) Address rd-drelsiNunimree
Haubstadt,IN 47639 Haubstadt,IN 47639 GIBBON COUNTY AUDITOR CB
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THI •"'TY.IDENTIFY AL •' -• ETHAT APPLY.
YES NO CONDITION YES NO CONDITION
[ ❑ 1.Will this property be the buyer's primary rd is . • --•
residence? Provide complete address of primary 0 El 4.Solar Energy Heating/Cooling System
residence,including county: i
679 S Curtice Lane 0 El S.Wind Power Device
Address(Number and Street)
❑ El 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ El 7.Geothermal Energy Heating/Cooling Device
ary mteztPCode County ❑ a"8.Is this property a residential rental property?
6121 0 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 0 tEl 9.Would you like to receive tax statements for this
complete address of residence being vacated, roperty via - rovide contact information
n, in_eluding county: below.Please see instruction more information.
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Address(Number and Stile) 26-12-15-200-000 . 335-027
flovlisbilf7 T !A/ 76 3(9' 4i450' Charles E.Shaw II Brenda K. Shaw
City,State ZIP Cade Primary property owner canmctname fi-mall
Vasty dgits of Buyer I Driver's State Lasts Digits of Social Security Number! !Last 5 digits of Buyer 2/Spouse Driver's State Last3Digits of Social Security
License/ID/OtherNumber Number License/ID/Other Number