Homestead_Leistner INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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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 (
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Brittany K.Marginet
Seller 1-Nome as appears on conveyance document Seller 1-Name as appears on conveyance document
956-5;"---57r5 S-Road '7 /� 956 a 7
5S S( s S' 1 WO L'. 1 5.65 W 3 RUM'
Address(Number and Street) ( �` `J v Address(Number and Street)
Owensville,IN 47665 Owensville,Rl 47665
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 ofSeller Signature of Seller
Brittany K.Marginet Q /T/ 2.p'LD
Printed Name ofSeller Sign ate(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYY)
"BUYER(Sl'atiffi. ffSlY.`APPLICA'itill,.FORVRO ER ittk ntititTI'ONS:. 15ENTIFY AL- s ITITEM ntrA APPLYIP_, AG' '' .
Jamie S.Leistner
B conveyance document Buyer 2-Name as appears on conveyance document
512-S-tad venue Gf 5(Q 5 (A) 6-7 C� j . 512 S 2nd Av,uuc.
I Address(Number and Street) (`/' `Al/ C(�/t 'l Address(Number and Street)
Pr.. `on IN�7G70 p(1, 1 A �+vA` t (!" (
DEDUCTIONS FOR THIS PROP ' " . P.. ' • PI : +.OSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
cif ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary iiiiimai—.:,_ _ _ . -eating/Cooling System
residence,including county: ❑ Q 5.Wind Power Device
9565 W 575 S Road
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Owensville,IN 47665 Gibson ❑ [Ef 7.Geothermal Energy Heating/Cooling Device
City,Stat ZIP Code County ❑ �g,Is this property a residential rental property?
❑ 2.Does the buyer have a homestead in Indiana to be ❑ RI 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide property via e-mail?(Provide contact information
complete address of residence being vacated, below.Please see instructions for more information.
including county: Not available in all counties.)
Address(Number and Street) q
Jamie S.Leistner d�r -II -0-20 0-0 di! , g i )-02
City,State ZIP Code County Primary property owner contact name E-mail
Number License/ID/Other Number