Homestead_Allbright INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Dana Belcher Processor
Preparer of the Sales Disclosure Form Title
2301 N. Burkhardt Road First Advantage Title
Address(Number and Street) Company
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Evansville, IN 47715 (
E-mail
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Jemma M. Modafari
Seller 1-Name as appears on conveyance documeirt Seller 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
6(00YVI \IP \)\) q101Z
E-mail 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".
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ia re of li , Seller Signature of Seller
Je Ira M. Modafari f-,,ef- I 2'
Printed Name o Seller Shin Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
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Charles Clint Allbri•ht
: er 1-Name as a ea • •nveyance document Buyer 2-Name as appears on conveyance document P
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Address(Number and Street) Address(Number and Street) Set) ..,
P(&no a)
E-mail Telephone Number C - E-mail
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APP 1'1.- —___
I Or,
YES NO CONDITION YES NO CONDITION
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$ III 1.Will this property be the buyer's primary X 0 3.Homestead
residence? Provide complete address of erimary ri rA' ,. . . ' ergy Heating/Cooling System
residence,including county:
tic' s -7 ZS E NI 111 5.Wind Power Device
Address(Numb,er and Street) . 0 El 6.Hydroelectric Power Device
F( kil (ISO; 11\) ),1 c,q 0) „ ,
(3-lbsOY) 0 ml 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
D z 8.Is this property a residential rental property?
0 \g, 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide D Z 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
C7f6 de 9 D- OCCI-050? --00
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number