Homestead_Elliott (5) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
/i:n.nf4�11l Shea_ �J Cinser
Preparer of the Paler Disclosure Form Title
7S2o Eaa/f e-L9 Blvd 5P- 2? Qee,'on.a� Tile. 5ervice5
Address(Number an Peet) Campo /
E-mail
{ §E SEggER(S)%CWAN:TOR(S) _ - v = -- /�
n /9 //C 4, t G-rCI..,I X L o rG�-1-, 5 CL {ram-,'
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance dace mczt
2ofo (,J d Z O' CIwkrIritv2 ug LJoodware, bri v2
Address(Number and Street) Address(Number and Street)
Eva-ns Vll I fe —N C177/ a G110.r,s v: //c 1 M V 77/ 2.
and co p as required b 1 w,and is prepared in accordance with IC 1-5,5,"Real Pr erty Sales Disclosure Act".
Signature of Sel l L7
ler / Signature of Seller
t,
/ _ Yt.L.AA el 2,4? / eC7 0 r& e.''7�l ' '6r e ( ire 2/C
esinci Name of Seller Sign Date(MM/DD/YYY1) Printed Name of Seller Sign Date(MM/DD/YYY1,
' ,,ER S)%GRSNtTEE(5) 1AttlilGAT1ONiFORPROP,ERTRYWA CI EDUCsT bleiENTdFY'AtiL�iIT,EMSSTHrATiArI PLY
�( /a I-L l l o )
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YES No CONDmON Y NO CONDITION \
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary\ n n 4•Solar Energyg/Cooling System
residence,including county: uLJ
((s6B 5• MO �✓• 5.Wind Power Device
Addr- Number and Street) �/ /� I ❑ ❑ 6.Hydroelectric Power Device
I • /SA I =/v V7C39 "i1 402. ❑ 7.Geothermal Energy Heating/Cooling Device
C ,State ZIP Code County
J ❑ 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 ❑ ❑ 9.Would you like to receive tax statements for this
complete address of residence being vacated, pro e via e-mail?(Provide contact information
�y incllding countcyy: Blow.Please see t "ons for more information.
fO'Y 5; (pchi,y 5/ree! Not available in all counties.
Address
r�b`r//Yd Street),
/)AlGrl, /1/ y76'ig2 C,ibs/,rt 26-22-12-300-002 . 270-024
City,State ZIP Code County
Primary property owner contact name E-malt