Homestead_Kite.I�DUS,\SnLESDISCLOSURF,FORN SDFID SDOID 777222 ' Pagr?
G.PREPARER
Emily Smith Closing Agent
Prepa�cr u%d�e Salcs Dist�losure Fonn iitle
'�''S S.E. MLK Jr., Blvd. Southwestem Indiana Land Title Inc.
!d�r.c. /XumLerandSUecQ
Ci9•. Smm. nnd'/.IPCode Telephone Nurrrber F.-moll
E. SELLER S GR.I�TOR S
Dannie L. Kite
Seller 1� kame as app�.�arson mmeyance dxument Se//e� 2- Nnme ns appev�rs m conveircntre document
671 Sleepy Falls, Box N-10
Addr¢s /�1'urnber nnd Soeet) AdAms (Nnmber ond5creet)
Evansville, IN 47712-
Teie honc Number E-mail
Under penalties of perjm-y, 1 hereby cer[i(y [hat [his Sales Disclosure, to [he bes[ of my knowledge and belief, is true, correc[
and complete as reqaired by Ia�J, and is prepared in accordance with IC G-1.1-5.5, "Real Property Sales Disclosure Act".
-Ja�n�,v�t. �-� lL',-Fe Gy ��,Q� �,',�(1�, A.� F
Siqnotvre o(Se➢e� ( Siymmre n(Seller
� N N� L. L. .-�e D EM�. I Si.,: -I� A I F
F ER 5 GRA�TEE S- APPL ATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITGMS THATAPPLY
IRoberta J.
Quyer]�Namcasoppavon - q�nntrdocvmenl Buyer2�Nnrneasnpparnnmm�vey�nn�edxvment
J
dddrcts �Numherond Sorre�) ACdrac (NUm6eranAStrre�J
Haubstadt, IN 47639-
7ele han E-mall
THESALFSDISCLOSUREFORMAIAI'BfUSEDTOAPPLI'FOHCERTdIVDEDUCfIOVSFORT .IDHNTIFYALLOFT HATAPPLY.
7'ES �tl0 'CO\DITIOY \'ES NO CO,�'DITIOY
Qx � 1.lNill [his property be [he buyer's primary . o
residence? Provide complete address of primary � � 4. Solar Energy Hea[ing/Cooling Sys[em
residence, induding county:
5052 E. 1200 S. . ❑ Q 5. 4Vind Po�ver De��ice
aaeress�NumheranJSo-eet) ❑ Q 6. Hydroelec[ric Power Device
Haubstadt, IN 47639 GIBSON
❑ Q 7. Geo[hermal Energy Heating/Cooling Device
Ciq•, Sm¢ %1PCode Connrv
�� Z. Does the buyer have a homestead in Indiana to be � Q $� Is [his property a residential rentai property?
vacared for this residence? If yes, provide ❑ Q 9. l'1'ould you like [o receive tax slatements for this
complete address of residence being vacated, property via e-mail? (Provide conmct informotion
including county: belo�v. Please see instructions%r more informatian.
Not available in all counties.J
AdJrees (Number und SlreclJ n
Ciry.Sro�eZIPCaCe County �'�`� � '��O l �/ ��� ' O� �
Primop•pmpeK}� onaer tonmct nome E-muil
Under penalties u(perjury, 1 hereby certify that this Sales Disclusure, lo the best o(my knotvledee 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 Ac[". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homes[ead Deduction is
being filed.J
�oher-(� J , �: �e- Gy �� S^.:.� , �1 � � '
Sig�mNreo(RqveN � � � Signamreo(Auyer2/Spouse
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h'umber Ucense/lU/OtherNumbei'