Homestead_Dewig INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Tiffany Hoon Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services .
Address(Number and Street) Company
Evansville,IN 47715 (812)759-5555 closings@regionaltitlellcom
regionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
-r S ' g .3< ti s. s.s E.L., L r �„g - -. 1
t _.. _'�-'.. _.__.....5�_: ..u. ��.__- . i_..�.:z ._ .`..- ,._,..�<.�,.:51�._ _.w�_. °:.. ._ ..__ mot -��.:�.� ... -� ,_.r_-. , `� k� 1,ti.,,..,.-Y_ ,..... �.�. -Y�._ti.,.
Susan Marie Brown
Seller 1-Name as appears on conveyance document Seller I-Name as appears on conveyance document
4606 Rathbone
Address(Number and Street) Address(Number and Street)
Evansville,IN 47725
state,and ZIP Lode state,
2, J''� _ / /� state,and LIP Lode
0 a-Z1 I c.J1L,V A(77/4
Telephone Number E- all 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/ 9!.�asJrequired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
)UAAD^., �/'ub
Signature ofSeller Signature of Seller
Susan Marie Brown 13 Jam%9
PNnted Name ofSel er Sign Date(M /DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYYJ
gritA itfigi G ACJ EE�ISI`'>�APP.ICAli'ION..FORTPROI?ERTA AX?tiEDUCTsIONS_ IDENTIR1rIAlIATEMMIAI's-APPLY�.��-. . �ia ....53, >
Shelton L.Dewig /
Buyer 1-Name as appear n conve e document
Buyer 2-Name as appears on conveyance document
1.05 S-Ma' . pt 2
Address(Number and Street) Address(Number and Street)
Fort Branch,IN 47648
State,and ZIP Code State,and ZIP Code
(CCM(pCA.18-n FILED
Telephone Number -m/14 Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPS Y:RgNTIFY ALL OF TI'MB- AT APPL , E 17 2019
YES NO CONDITION S NO CONDITION f�=e'7".
E ❑ 1.Will this property be the buyer's primary [54 ❑ 3.Homestead e BSON COUNTY AUDITOR CB
residence? Provide complete address of primary ❑ n- : Heating/Cooling System
residence,including county: Q 5.Wind_P_ower Device
201 W Mulberry St
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 8.Is this property a residential rental property?
❑ ® 2.Does the buyer have a homestead in Indiana to be El 9.Wou �u like t ceive tax statements for this
vacated for this residence? If yes,provide property via e-mai
((`` l?(� P v deCont t information
complete address of residence being vacated, below.Please see instructions for m:ell* mation.
including county:
Not available in all counties.)
Address(Number and Street) 26-12-07-304-003 .2 51-028
Shelton L.Dewig /1
City,State ZIP Code County - r ,pertp.oivnvrcontactname ` E-mall
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".(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bei gI} filed.) / '
Signature of Buyerl Signature of Buyer2/Spouse
Shelton L.Dewig --1. —1°1
Printed Legal Name of Buyer 1 Sign Date(MM/DD/YYYY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DO/YYYY)
5531.16 14 ,Sc6b
Last 5 digits of Buyer 1 Driver's State Last 5 Digits ofSocialSecurity Number !Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits ofSocialSecurity
License/ID/Other Number Number License/ID/Other Number