Homestead_Gardner Jr INDIANA SALES DISCLOSURE FORM SDF ID Page
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Tim Shea 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 • (
"Ailki. -.-r,. . .s di�+�rWMa' iaim c-1,:ssc". ag c r1 2. . ala: Pa r3 iSttiWiti
ri Masaharu Yamashita
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
3717 Pebble Place Drive 3717 Pebble Place Drive
Address(Number and Street) Address(Number and Street)
Evansville,In 47711 Evansville,In 47711
Telephone Number E-mail
Under penalties of perjury,I ereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and comple e as requir d b assr,land is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
1tlAt .
Signature her � I� �O� Signature of Seller
Masan amashita '
Printe e-ofgel Sig Date(M /DD/YYY1) Printed Name of Seller Sign Date(MM/DD/YYYY)
r..nT YE ,�S /GRAI+Img g.. AI1PLl� '6PI:ONI lidllf ORER'I :< Ah b DU,I ON i=i[DE IR A"LI� tI M6 THAA'I:AAA Y
Jesse E.Gardner,Jr. Christopher R.Neibert
liaJta, n"P^sue ar.�on conveyance document Buyer2-Name as appears on conveyance document
6011S450W 6011S450W
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665 Owensville,IN 47665
E-mail
THE SALE ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP1I .IDENTIFY ALL OF"[IDS THAT APPLY. FILED
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead May 18 2020
residence? Provide complete address of prima 7 nergy Heating/Cooli�
residence,including county: ❑ Q 5.Wind Power Device
10528 E State Road 64 GIBSON COUNTY AUDITOR CB
Address(Number and Street) ❑ 10 6 ydroelectric Power Device
Oakland City,IN 47660 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZlP C de County ❑ 8.Is this property a residential rental property?
El2.Does the buyer have a homestead in Indiana to be ❑ Q 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide roperty via e-m • . vide contact information
complete address of residence being vacated, below.Please see instructions more information.
including county:
Not available in all counties.)
Address(NumberandStreet) Q613-24-100-001. 195-006
Jesse•E.Gardner,Jr.Christopher R.Neibert
City,State ZIP Code County Primary property own -nenme E-mail