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INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Anqie Pace Title Assistant
�Preparer o/the5alc D'udomre Form Title
�911 Lincoln Avenue Clear Title Comoanv
Address (NumbuandStreeQ Company
Evansville IN 47714
Email
E: SEIiLER S ',GRi1NTOR S ..�. 5:'_ _ , :.' _ , ....-.:e . .o;- . : ,rF � ,,_ _. "t :
KoN I am6 Casey Lamb
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Under penalties of perjury, 1 hereby certify [hat [his Sales Disclosure, to [he best of my knowledge and belief, is true, correc[
and com le[e as requi d by law, and is prepared in accordante with IC -1.1-5.5, "R I Prope Sales Disclosure Act".
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Signatvreo/Se r Sig�a[u� o/Seller
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F.•BU TEES'=APP.LICATIONFOR+PROPERTY-TAXDEDUCTIONS-IDENTIFYALL-iTEMSTHATAPPLY,'.
Lac A. Bertram
Buyerl�Nameatapp nromq�an�edxummt Buyer2�Nameatappmrsonronvryanredwumml
302 N. C urc St.
Addras(NUm6erandSvreQ Addrst(Numberand5veet)
Fi. Branch IN 47648
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E-mail Tele honeh'vmbe� E�mail
THE SALFS DISCLONRE FORA1 MAV BE USED TO APPLY FOR CERTdI\ DEW L7ION5 FOR THIS PROPERTY. IDE\TIiY ALL OF THOSE THdT APPLY.
YFS NO CO\DITIOY \0 COYDRIO\
�✓ � 1. Will this property be the buyer's primary Q ❑ 3. Homestead
residence? Provide complete address of prima , •nergy Heating/Cooling System
residence, including county:
709 N Churrh St ❑ ❑� 5. Wind Po�ver Device
AAd�eu (Num6erand5umt) ❑ Q 6. Hydroelectric Power Device
Ft. Branch IN 47648 Gibson � Q 7. Geo[hermal Energy Heating/Cooling Device
Ciry, SmreZ/PCode Covnry
� Q✓ 2. Does the buyer have a homes[ead in Indiana to be � ❑��y 8. Is this property a residential ren[al property?
vacated (or this residence? If yes, provide ❑ LJ 9� Would you like to receive [ax statements for [his
complete address of residence being vacated, property via e-mail? (Provide contact information
induding county: 6elow. Please see instructions%r more information.
302 N Church St. Not availa6le in all countles.)
Address (NvmberandStree[f
Ft. Branch IN 47648 Gibson ��-i9 �� �Q/ �� Qo��a �/
Liry,SmleLPCOde Covnry � �
Pdmary proyerry owner mn:act name E-mail
Under penal[ies of perjury, t hereby certify that this Sales Disclosure, to [he bes[ of my knowledge and belief, is We, correct
and complete as required by law, and is prepared in attordance with IC 6-1.1-S.S, "Real Proper[y Sales Disdosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
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