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D. PREPARER � � � - . �. - � --
Lisa A Carter Closing Agent
Aeram o(tAeSolrs Ois:larvv Porm Title
7820 Eagle Cresl Blvd Ste 201 Regional Title Services LLC
,1EJres(8um5eranJSVr�J Campcny
Evansville, IN 47715-
�F.�. SGCCER Sl/GRANTOR S -�� ' � � -- . .:. ,. � � . . . . . ..., . . . .:. .,. .
Beverly C Marshall
SHler 1- Xame ov appeaa on cmnewnre drcnment Se(ler? . p'nme asnppevn a: wnve}m�e dotument
a811 Granada Blvd
.4ddress (Sun�ber and S�'r?t) AJdress (Numbrr unC Su<et)
Sebrin9, FL 33872-
Cip�.Sm[e vnd LPCod^ G.y, Smtq mvd ZIPGaIe
E�nnil TefeilwnrM1'umfrrr E-nmil
Under enalties o(peryury, I hereby certity that this Sales Disclosure, to the best o(my knowledge and belief, is true, con�ect
and � plete as require by law, and is pre ^arned �in accIordance with IC 6d.1-S.s, "Real Properry Sales Disclosure Act".
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Siyoa:urcoJSe;tri Signamrce/Shccr
'Beverl Marshall 06/30/2011
•.13UYGR S GRANT G S--APPLICATION fOR PROPHR7'1' TAX D• '1'IONS= IDL'N L ITGM1iS TFIATAPPhY ' -
Christopher R Collins Kendra N Collins
Buy.rt-Nvme �.�.rvnonronrewmredoaumen: Buyerl��tlumemoypeanunmr-�onaeCocvmmt
80 5 3
AJdras (NUmS�i ondArveQ Adarrss (ifumbm oW StreeQ
Foh Branch,IN 476C8- Port Branch,IN 476:8-
�Cirv Srate, andZlP Code Clry, Sm�e, nnAZIP CoEe
Enmil Tde hnneNumFrr E�niall
TNE5,ILESOISCLOSUREFORM1IMAYOEUSEDTOAPPL\'FORCERTAIYDEDURIO�SFOPTHISPROPE ETN,ITAPPLI'.
1'ES KO COYDITION YES NO COYOITIO\
❑x � 1.1Vi11 this properry be the buyer's prima , Q ❑ 3. Homestead
residence? Provide complete addres of pr nary � � 4_ Solar � gy Ileating/Cooling System
residence, including counp�:
177 E 780 S . Wind Pou•er Device
AJd�ess(fAmibrrundS.'reet) ❑ Q 6. Hydroelec[ric Power Device
Fort Branch, IN 47638 GIBSON � � 7. Geothermal Energy Heating/Cooling Uevice
CintSta;eLlPCode Caunry
��] 2. Does the buyer have a homestead in Indiana to be ❑ � 8. Is this property a residentlal rental propercy?
vaca[ed For this residence? If yes, provide ❑ Q 9. 4Vould you like [o receive tax s[atements for this
complete address of residence being vacated, propert}• via e-mail? (Provide contnct informotion
induding county: 6efoue Please see instructions(or more in%rmation.
Not availoble in all munties.)
ACdres (NCm ber and S:rceQ ��ff/ /j /( q
fiq�.SmtrZIPCnAe Cnunry ^��r� /�'�O�' V�l•��p[ — ���
PnmarvVroperq�own¢: ronmr[nume E�mall
Under penalties uf perjury, 1 hereby cerlify that this Sales Disclosure, lo lhe besl uf my knowledge anJ belie(, is true, correc[
and comple[e as required by law, and is prepared in accordance with IC Gi.l-5.5, "Real Pro erty Sales Disciosure Act". (Note:
Spouse information, Social Security and Dri��er's License/Other numbers are not necessary o Homes[ead Deductlon is
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