Homestead_PackCaroline Schneider
Preporer oJtheSales Diulmure Form
Evansville IN 47715
Clry, Smte. and ZIP lode
Se!ler ]- A'ame u appmrs om m�veyann document
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Addmst (A'vmber ond Svee+)
Fort Branch IN 47848
Title
Reqional Title Services. LLC
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Seller 2- Name as appears on ronve�vnce dorument
.tddress (A'umber and Slrcet)
li9•. Smte. and ZIP lode
Under penal[ies of perjury, 1 hereby certify that this Sales Disclosure, to [he bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with 1 6;1.1-5.5, "Real Pro rty S es Disclosure Ac[".
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Signamreo/Selfer 5gnany�o%Seller � , , /
10/21/2011
Buyer 1- Name ac�rs on conveyanae doaumen[
on canvq�ance
3116 Debbie Lane
Addrcs (Number and Stme[)
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Evansville IN 47717 Evansville IN 47711
Ciry.
� T I ph h' ber E-ma'l Telephoneb'umber E-mai!
THE SALES DISCIASURE FORM A1AV BE USED TO APPLY FOR CERTAIN OEDIIRIONS FOR THIS PROPERTV. IDENTIFY ALL OF THOSE THAT APPLY.
5"ES NO CORDITION
� � 1. Will this property be [he buyer's primary �
residence? Provide comple[e address of primary
residence,, including county:
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� � 2. Does the buyer have a homes[ead in Indiana to be
vacated for this residence? Ifyes, provide
complete address of residence being vaca[ed,
�
Counry
Heating/Cooling System
5. �Nind Power Device
� Q 6. Hydroelectric Power Device
'❑ ❑✓ 7. Geothermal Energy Heating/Cooling Device
� ❑J 8. Is this property a residential rental property?
� ❑✓ 9. Would you like [o receive tax sta[ements for this
property via e-mail? (Provide contact informotlon
be(ow. Please see instructiais�or rnore information.
No[ availa6le in al! counties.J
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Under penalties of perjury, 1 hereby certify tha[ fhis Sales Disclosure, to [he besl of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse in(orma[ion, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
being filed. � �
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