Homestead_Campbell (8) INDIANA SALES DISCLOSURE FORM SDFID: Paget
Jamie 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 (
d +aYr1 se : . rfe'uta; ° -r' k a ` ^er'ti• w�- s-tr„Dr r
.--..� _ � 3t�. �-.�^�'-n�..[sL'Ssr.,.ra--,+3s-z�.a 'r
''v✓nifo, L. 11.041 .
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
'3S6 E TtCiwv. 24c4,1
Ad ss(Number and Street) Address(Number and Street)
rt' `� 7 67o
n e mateana Llrcoae
• 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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature ofSeller
Warren L. West g)/6 /C/
Prim e o Seller S n Da (MM/DD/YYYI) Printed Name of Seller Sign Date(MM/aD/rrn)
MiliYE1481,GRRN,TEE(811. afA Lri(3:ATION'RORTEi20PERTSitOtlDEDUCTiONSgiIDEN111FaYAILLRITENIS HATAPPGY t 4 t-.
Jennifer Lynn Campbell
uyer1-Name as app�on 'document • Buyer 2-Name as appears on conveyance document
rag um an trees' Address(Number and Street)
.1— , -I 7 LelG
Number E-mail
Sep 05 2010
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. ID ALLOF_THOSE THAT APP
YES NO CONDITION NO CONDITION �f
CA 0 1.Will this property be the buyer's primary / ❑ 3.Homestead GIthON COUNTY AUDITOR CB
residence? Provide complete address of primary ❑ p 4.Solar Energy 'ng/Cooling System
residence,including county: owcr Device
1386 E Taftown Road
Address(Number and Street) 0 0 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ Q Geothermal Energy Heating/Cooling Device
aty,smCe ZIP Code County ❑ 8.Is this property a residential rental property?
❑ c2f 2.Does the buyer have a homestead in Indiana to be ❑ m 9.Would you like to recei tatements for this
vacated for this residence? If yes,provide
property a- -mail?(Provide contacti'hformaion
complete address of residence being vacated, below:Please see instructions for more inf orTrt tia
including county: not available in all counties.)
Address(Number and Strut) / 26-12-05-400-003 . 523-027
Jennifer Lcnnn Campbell
my,State ZIP Code County
License/ID/Other Number