Homestead_Sullivan .• • ••• •• • . .. .. . . ,. , . ... .
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Preparer of the Sales Disclosure Form Title •
Katie Felty Escrow Officer
_
Company
Address(number end street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
a‘SEITLER(6)MRANTPR(S)."::::-...- •• -: ..1:.::-...:....'• :.."::- ... :......::•;::• ..:- ::"i ••• :::" .:- : .i.•..:..;,..:•:. .':--:.•';'-'..:;.::. :::-. •.•••
Seller 1-Name ash appears on conveyance document Seller 2-Name as appears on con ce o A
Theresa J.Coomer 1 41/4 ,
Address(number and street) Address(number end at i j?
(I 2,02.51...) .
City,stale,and ZIP Code City,state, P. ode
izt
V c; C2 Counby Country Ou,,,, • ..1.-,
US US 'vtKit.?4'e4
4)tr
E-mail address Telephre number E-mail address •04 Telephone number
( ) ( )
iiniliei'jianeitlea or perfaiiiherebi'eerigy, this Sales DIscieleare,:toIth'ebetit•cif my.knOwledgiand belief,ffe true,correct complete as
,
?karma bilawi jintrIe prepered,10 accetotree'wlithfC 1-1165.6.•A.flOraOn Why litiOWIngly and:Intentionally:retained the value ortrItnnfOrredI:
real property;.0r.omits nrfalalfida any 1610111On tegulredlo be provided,commits a Level 04160, •..--- '•.:. " :',:' ---';•,.-•II•- '... : •..:'
Signature of Seller
Signature of Seller
Printed Name of Seller Date signed(mm/ddryyyy) Printed Name of Seller Date signed(mmicidiyyyy)
Theresa J. Coomer 1 •
• .4. liv)r.63(8)10.RANTE. ..g(s):.7,Apeu0ATIOLFOR.PFiptipikrTAkr*Eiii0ION IDENTIFY ALL ApKY'.,.:''',„:::•'::- .
Buyer 1-Name es it appears on conveyance documint Buyer 2-Name as it appears on conveyance document
Skyler Sullivan Carol Shaffer
Addrpsstnumber an stree.§ . 5 I Address(numberearg .2i.ji), $(9.1/0-)
kP(0 I le (P
F
Clly,sta0an nCodeekon ctn. fill"1(01D City,state.a rIP Code tn cO Th-tion1 , 147(p70
.
-Country 1 Country
US US
E-mail address
:.•: ••:: •
yEs NO CONDITION I YES NO CONDITION
c3 0 1.Will this property be the buyer's 1)1 rirnary 0 0 3.Homestead
residence?
0 C) 4.Solar Energy Heating or Cooling System
1 -
0 _rii 2.Does the buyer have a homestesd to be vacated 0 (!Jvifi 3 5. nd Power Device
\'..11 .,for this residence?If yes,provide address: 0 0 6.Hydroelectric Power Device
Address(number and street)
0 c 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
, Oli2— 1-a-N.9, -J.-too - )CO.( (--(CS— 0Q17
Under penalties of perjury,I hereby certify that thit?ilea DlactOstiro,to the beat of my knowledge and belief,is true,coattail and complete
earegolied:bY low,and la prepared In accordance Ith.IC 6-1.14.5.&person who knowingly and Intentionally telettiee the veil two!:..
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