Homestead_Bachman i .
INDIANA SALES DISCLOSURE FORM SDF ID - Page 2
,D PREPAR E -
Dana Belcher Processor
Preparer of the Sales Disclosure Form Title
2301 N. Burkhardt Road First Advantage Title
Address(Number and Street) Company
Evansville, IN 47715 (
City,State,and ZIP Code Telephone Number E-mail
E SELLERm%GRANTOR(S)T-, y.z
Alit Saliju Florent Saliju
Seller 1-Name as appears on conveyance document Selle 2-Name as appears on conveyance document
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Address Number and Street) Address(Number and Street)
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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".
Signature ofSel Signature of Seller
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Alit Saliju �j�21�� Florent Saliju
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
P BUYER(S)%GRANTEE(S) APPLICATION FOR?AROPERTYTA*tED tit TIQNS, 1_DENTIFYALLITEMSTHATAP.PLY ,,_,,
Robert A. Bachman
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document,
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Address(Number and Street) Address(Number and Street)
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City, de City,State,and ZIP Code l
Telephone Number E-mail Telephone Number (:i4 ®Q� 1nail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOS LY. D,9
YES 6 CONDITION YES NO CONDITION 'l'co J
[ ❑ 1.Will this property be the buyer's primary [�❑ 3.Homestead 041/), ' `----_,_
residence? Provide complete address of primary ❑ ❑✓ 4.Solar Energy Heating/Cooliripy„stem
r ide ce,includin county: )s
0❑ 5.Wind Power Device 0 r
• ress(NuinlierandStreet) �/ (� ❑ ❑✓ 6.Hydroelectric Power Device
It ra � 76 0 (V)o` , ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
Ill 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 ❑ 0 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) 1�,1/�
City,State ZIP Code County ' `
Primary property owner contact name E-mail
Number License/ID/Other Number