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�DIASa ���LF,S DISCI.OSGRB FORVI
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. PRENARER_ . `.... _., � , � _. . . .
WALLACE
605 S. E. MARTIN LUTHER KING JR. BLVD.
Addrcss (ASm�brrnnJSJrctt)
EVANSVILLE, IN 47713
Cint Sm(r. and ZIY Gwr
. SELLER(S)7GR.C\TOR(S) -
DEREK V. MARTIN
SDF ID 26-2009-1000785
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TYPIST
Se/ler- �tlani[ na rsyyears nn ronrecnncr Axumrnt
ROUTE 1 INDIAN HILLS
Addre.ec p\SimLer mul5rree1l
FT. BRANCH. IN 47648
Cint St✓tr, rznd LP Codr
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�� P�gr 2
Soutlnvastem Indiana Land Titb Inc.
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TAephoue �\5unber E�mnil
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Srllrr - Nnrnr n.a npprms mi tnrn•crmire
Add�rss (��'�unber mid Shee4)
Cirr. S�rtre. and "l.fP Cndr
Rfcyhone
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nder penvl[ies of perjun�. 1 herebvi cer�ifi' that this Sales Disclosure, [o [he best of my knu��'ledge and belief. is true, correct and
implete as required br la��', and is prepared in accordance with IC fi-1.L�.�, "Real Proper[c Sales Uisclosure Act".
.�yIT,L� ✓. � /�'10.�tiu. � 1�1�/L� ��
Sigimrure af Sr(Irr
Derek V. �1artin bv Fmilv Smith, AIF
K. VENDREIY V' � U �
�Vnmen.�nyymrs, ronrernncrAorumem m��a_z'
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FT. BRANCH, IN 47647
Cifc. Srntr. m�d JlY Crxlr
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'HF. SdLFS DISCI.OSUNE FORJ� �Id\" 6F USED'PO dPPl.l' FOR C� AI\
� 1. �1'ill this propern• be the buycr's priman• residence?
complete address oi priman• residence. includine cour
706 W. WILLARD STREET
.aJdrccs (:Vumhtr nud Svrrq
FT. BRANCH, IN d7648 Gibson
Cin•, S�urc. urul "LlY CoAe Counrr
r 2. Docs the buyer have a homcstead to be vacated (or �hic
residence'? if yes. provide complete oddress of residence �•acatin_.
includine countv:
.IAdrett (�\4urthtr nnASlreR)
Si;wmrr of Scllrr
Prinled A'nn�r of ScUrr Sign Uutr (:ll.11/UDA7'Y"}'1
iT� �ts TH,��r:avv�v � _,.r
Hin'rr -,Vnrnr n> upprms on aonrecane e dnrumrrv
AAArec� L�Snnber and S�ireO
Cip'. 5(ale. arzd7JP Caic
)GCflO\S FOR THIS
� 3. Homestcad
r Y. $olar Enerov I
r i. N'ind Power Derice
S�•�[cm
r 6. Hydroelectric Po�rer De�•ice
� 7. Gcothcrmal Encre�� HcatinJCoolin_ Dcvicc
j— S. 1> this propenq :i residential rcntal propeay'?
THAT
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�?G -i4�P-3�3 -
Ci(r. Stmr, rmdTJP Codr Counrv
n er pena t�es o per�ury, ere c ceru r t iat t is , a es isc osure, to t e est o mc -now ec ge an e �e . �s vue,
complete as reyuired b}� law, und is prepared in accordance ��'ith IC 6-LI-:S, "Real Propern� S:des Disclosure Act".
K. Vendrely by
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Smi`th, AIF
Sign Dnre (,NAI/DUQ9')"YI
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Pnnled �tlmnr nJBiner Si:n Du�r (,4L41/ODn7'Y}')