Homestead_Carlile •
INDIANA SALES DISCLOSURE FORM SDF ID: 2019 Page 2
D. PREPARER
Kristina Watson Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street)
E. SELLER(S)/GRANTOR(S)
Brian Stallings II_
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance u y
4669 E Dead Level RdpO\\\\YYJ1,,
Address(Number and Street) Address(Number and Street) ri.°
Hazleton, IN 47640 ````�l�_
E-mail Telephone Number `ia CQJ E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and #1, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Saps\bisclosure Act".
r an cv
Signature of Seller J � ` Signature of Seller
\,Brian Stallings \q
Printed Name of Seller Sign Date(MM/DD/YY,YY) Printed Name of Seller Sign Date(MM✓DD/YYYY)
,- -- -iim:c::eeR4 PPLICATION FOR PROPERTY T s P I WAWA .. .-.-,____Y ALL ITEMS THAT APPLY
-qui
Kimberly Carlile Michael Hornick III
n er 1-Name as ap.-_.. .n conveyance document Buyer 2-Name as appears on conve :nce document
1500 W Florida St 1500 W o •-
Address(Number and Street) Address(Number and Street)
Evansville, IN 47710 Evansville, IN 47710
Y_ ES NO CONDITION YES N ON
ru z D 1. Will this property be the buyers primary 0 3. Homestead
residence? Provide complete address o imary ❑ 4. Solar Energy Heating/Coo' System
residence, including county:
4669 E Dead Level Rd. vvn -Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Hazleton, IN 47640 I Gibson 0 ❑ 7. Geothermal Energy Heating/Cooling Device
it, State ZIP Code County 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ q Would you like to receive tax statements for this
vacated for this residence? If yes, provide complet property via-e i . rovide contact information
address of resiqpnce being vacated, includirfg county: • rmore information.
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* f �t/Xes,de e / Not available in all counties.)
Addr s(Numbs( Sr
�a,tfrf/ 4-srdedNv oa .e-dl - 113-boo .40�o-O\-]
City,State IP Code2 linty Pr, t operty owner contact name E-mail
771 7