Homestead_Blumenstock INDIANA SALES DISCLOSURE FORM SDF ID
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Timothy Shea Processing Coordinator
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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Household Thoughts,LLC
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
7199 Newman Road
Address(Number and Street) Address(Number and Street)
Elberfeld,IN 47613
Number E-mall
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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Signature ofSeller 1/ Signature ofSeller
Brian Ellis,Member 1'I D
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
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>I?LICAtIOlaORyEKSPERTY:�.�'iIAXiDEDUCiPI0M..TDEIVTIRkfAtISN7'iIEtMlHAbAPPT�YMf at.,.�alsa
Kenneth E.Blumenstock
er 1- ocument Buyer 2-Name as appears on conveyance document
110 I son Street
Address(Number and Street) Address(Number and Street)
Telephone Number FILED E-mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPL I 13 20•
20
YES NO CONDITION YES NO NDITION
❑ 1.Will this property be the buyer's primary /I ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary /111 0 . o ar nergy Heating/Cooling System
residence,including county: ❑
3437 S 100 W piS.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Princeton,IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ V 8.Is this property a residential rental property?
❑ 0 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 inst :r more :tion.
including county: Not availa•• • ' all counties.)Address(Number and Street) 6—11—2 5—3 00—002 . 168—02 7
Kenneth E.Blumen :-
License/ID/Other Number