Homestead_MarginetINDIANA SALES DISCLOSURE FORM SDF ID: ` Pa e 2
D:,PREP,ARER' °v �. ��_� r ;£_ :v. c� .��� � i°'� .L' �� �au��' .�, i'� i� ,
LANA C. HARPER CLOSER
� Preparero(lheSaluDisclosureForm Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES. LLC
Address (NUm6er and StreetJ Company
EVANSVILLE. IN 47708
E-mail
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.��E: SELL'ER S �- �GRANTOR 5 ..c t"w�..,�..9 .1; 'q�,. - �tts,�-�; �:._: _�u,,:_.� �r. , � a':'�i'. o-,z,:..,,� m-�,-�s�a�:�.;ir k > .t-; ` `=::�
JEFFREY M.GOLDBACH
Seller ]� Name as appenrs m rom�eyanre documen[ Seller 2- Nome as oppears on conrevance dacumen[
73� �. S{ate 5�.
Add� (Num6erand5treetJ � dddreu(Numberand5tree[J
F'Irnce.�or� IN `l7�O?D
E�muil Tele honeNumber E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and complete re r d law, and is prepared in accordance with IC 64.1-5.5, "Real Property Sales Disclosure Ac[".
S(gmNreo(Seller R SignaoveoJSefler �
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,�F:`�BUYER S ,GRANTEE S �`'APP.tiICATiON EORPROP,ERTY,TAX��DEDUGTIONS`;IDE�TIFY=A�tiITEhiS�THATAPPLY `'' "�'�- ''�•' �
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JANE E. MARGINET
Bvyer }- Name as appean on ronveyance document Buyer Z� A'ome as appevrs m tonveyanre document
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Ciry.Smre, andZlPCode Ciry.Smce, and ZIPCade
iele honeh'umber E�moil Tele honeNumber E-mail
TNE SALES DISCLOSIIRE FORM MAY BE USED TO APPLY FOR CERTAIN DEDURIONS FOR TNIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
VES NO COFDITION I �S NO CONDITION
Q ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide �omplete address of primary � � 4. Solar Energy Hea[ing/Cooling System
residen including county:
�n � � �,� � � � � 5. Wind Power Device
��°���"�mbe.and�``y n I `,�Q%�(.� ❑ � 6. Hydroelectric Power Device
C f�u4�C6'� ''v �� lU `1VL..,L�� ❑ � 7.GeothermalEnergyHeating/CoolingDevice
Clry. 5mte ZIP lode unry
� � 2. Does the buyer have a homes[ead in Indiana [o be � �$� �s this property a residen[ial rental property?
vacated for this residence? [f yes, provide ❑ � 9� Would you like to receive ta� sta[emen[s for this
complete address of residence being vaca[ed, property via e-mail? (Provide contoct information
including county: belaw. Please see instructions/'or more information.
Notavaila6/e in all counties.)
Address (NUmber ond SveetJ
�19-�9-�9-zoyadl�3/ 9da �,_
liry, Smte Z/P Code Counry
PnmarypmpertyownermnmRname E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o the bes[ 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 Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being f led.)
Signau�re 8vyerl � SignaaireofBwer2/Spovse
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so%Buyer]D�iver's Smte Las[SDigiGSO�SonalSecurityNumber LastSdigifso%Buyer2/SpouseDnver's Smte LastSDigiCSafSocialSetunty
License/!D/OtherNum6er Number Lirense/lD/DtherNumber