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�iND1ANA SALES DISCLOSURE FORbt SDF ID: Pa e 2
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D: PREPARER' - - +, . _� , ' " ' F:.' _ ri
T Micheile Havnes Ciosinq Aqent'
�3eparer af the $olrs Disdawre form Title
1 Main Street. Sie 101 Bosse Title Comoanv
Address(NumberaadSaeeQ Company
Evansville, IN 47708
E-mail
E.SELLER S GRANTOR S � - ".r - `. ;, _ ..` -`� '_,-- `
�agpry A. Rnr9rr ponna K_ Bur9er
Seller ]- Name as oppears on ranveyontt doavment Sefler 2- Name as oppears om m�veyanoe davment
6250 S 175 E 6250 S. 175 E.
Addrea(Num6erand5trret) Addras(NUmberand5treetJ
Fort E3ranrh IN 47648 F�rt Pranch IN 47fi4A
Ciry, Smre, and ZIP Code Ciry, Sru¢, and ZIPCade
E-mail
Under pena ties of perjury, l hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and com e as required, aw, and is prepared in actordance wi[h IC 641-5.5, "Real Proper[y Sales Disclosure Act".
' Signamreo(Sel! gna�of5e11�+ K• ' J�
Donna K- BurQer OSI04I2017
PnnredNameo Seller Si nDatefMM00 PrinredNameo Seller SiunDamfMM00
S� G � S'-A2PLICATION�FOR�PROPERTYTAX ONS= F.YALLITEMS��THATAPPLY '.';��.� - -"
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M�eheel�J. onraih Kaci M. Konrath
Buyer7-A'ameas ^ onromryanredotument Bvyer7-Na pearsonronvrynnredocvmm[
1 o Main Drive 1010 North Main Drive
Address(Num6erand5treet) . Address(Num6erandStreet)
��akland Citv IN 47660 Oakland City IN 47660
ry. Smre. md ZIP Lode liry. Sm[C and ZIP Code
E-mail
THE SALFS DISCLOSURE FONhf A1AY BE USED TO APPLY FOR CERTAI� DEDUCfIOYS FOR THIS PROPER7Y. IDEhTIFY ALL OF TNOSE THAT APPLY.
YFS NO C0IDITIOY I CO\DITIOh
�✓ � 1. Will this property be [he buyer's primary ❑✓ ❑ 3. Homes[ead
residence? Provide complete address of prima , nergy Heating/Cooling System
residence, including county:
304 , � � Q S. Wind Power Device
Addrecs(NUm6erand5veetJ ❑ ✓❑ 6. Hydroelectric Power Device
Fort Branch IN 47648 � Q 7. Geothermal Energy Heating/Cooling Device
Ciry, Smre ZIP Code Counry
� �✓ 2. Does the buyer have a homestead in Indiana to be � ❑� $• �s [his property a residen[ial rental property?
vacated for [his residence? If yes, provide ❑ ❑� 9. Would you like [o receive ta�c sta[ements for [his
complete address of residence being vacated, property via e-mail? (Provide contact in%rmadon
including county: belaw. Please see ins[rucdons for more information.
Not availa6le in all munqes.J
Add�es (Numberand Street)
01� - /�-�9-/o/-Gao. d - d a�
Ciry.SmreZIPCOOe Caunry
Pnmary P�perty owner ronmct name Email
Under penal[ies of perjury, I hereby certify tha[ [his 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 6-11-5.5, "Real Property Sales Disclosure Act". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.) , � � /
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SigmmreaJBuyerl / \f�gnamreaJeuye�2/Spoux
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Kaci M Konrath O5I04I2011
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eri Sta[e Las[SDigi6o�Sorial5ecurityNum6er LastidigitsofBuyer2/SpouseDriver's Sm[e Los[SDigiGSOfSo[ial5eruriry
License/ID/O[herNum6er Num6er License/1D/OtheM'um6er
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