Homestead_Simmons (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
, D.PREPARER
•
Christina Latham Title Clerk
Preparer of the Sales Disclosure Form Title
4500 WASHINGTON AVE.SUITE 102 Regional Land Title
Address(Number and Street) Company
Evansville,IN 47714
mail
E;SEL LER(S)CGItANTOR(S)` _ — -_ - -
ANN M BFIILIGMANN
/iSeller 1-Name as appears on conveyance document Seller2-Name as appears on conveyance document
" 9(34'/7 2c cdeal ooJ ,fir%✓er
Addy.t(Number and Street) Address(Number and Street)
,, ,
this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and/ -plete as requi •d by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
vv..-
SignatureofSeller Signature of Seller
ANN M BEULIGMANN /747tle?Q
Printed Name ofSeller Sign Date(MM/DD/YVYY) -Printed Name of Seller Sir Date(MM/DD/YYY)
P RTS)/CRANTEE(S):-:A CATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS.THAT APPLY
CLYNDSI RACHELLE SIMMONS LUKE BENJAMIN SIMMONS
Buvgr I- mars conveyance ti Went. Buyer2-Name as appears on conveyance do omen
.. X /2 222- w. , 4AC ei-
Address(.unit c and Street) • Address(Number and Street)
te1,4"S'V/1e JAI 4'7 7 2,j
City State,a Code
YES N CONDITION YT' NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead Mar 30 2020
residence? Provide complete address of primary U i 4.solar hnergy Heating/Cod r—
residence,including county: El IA 5.Wind Power Device
GIBSON COUNTY AUDITOR CB
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
❑ 0 7.Geothermal Energy Heating/Cooling Device
City, ate'ZIPCode County
0 2.Does the buyer have a homestead in Indiana to be El ❑✓ 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
below.Please ctionsfor more information.
including` e , county: f
V ty , W ,,,CA-Lk of available in all counties.)
Address(Number an
5U 4ti4 UoId ti 26-19-18-101-001. 160-026
City,State ZIP Cade Cou
tier cuncact name E-mail