Homestead_Coomer (9)� INDIANA SALES DISCLOSURE FORM SDF ID: t' e 2
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SHANNONLIBBERT MANAGER
PreparrloJtheSalaOisdmvreForm Title �
03 THEATER DRIVE REGIONAL LAND TITLE
Addras(NumberandStreet) Company
EVANSVILLE IN 47715
iEhSEL'li8R S °.Gi2i1NTOR S � �'��`'�`��"�'���' �'� ����j �
DOI IC; MFSSAMORF
Seller ]- Name as appmrs on ronveyanre dacvment Seller 2- Nome as appmrs on ronveyanre docvmenr
SFi77 EPWORTH ROAD
Addres (Number and Svee!) Addrgs (Number and Stree[J
NFWBURGH IN 47Fi30
Liry, SmrG and ZIP Code Ciry, Smt� andTJPCode
E-mail Tele honeNumber E-mail
Under penalties of perjury, t hereby certify that this Sales Disclosure, to the best of my knowledge aud belief, is true, correct
a�te as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act".
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5(g aNreofSeller n / SignamreofSeller
DOIIG MESSqMORE //� /' �
PnnredNameo Seller SianDate(MS o Rin[edNamea Seller Si nDate(MM/DD
GF�BUYER S'.GRAj�TEE S $=�AP.PtiIGAT10N`sFOR�P:ROPERT:Y�TAX'DEDUCTtONS,-��IDENTIF,YIAL'L�ITENISiTHATrAP.P.LY � � _�{�°�;
Theres J Coom r
Buyerl-Nameasappmrsomm� unredocument Bu}ml2-Nameasappmrsomm�veyancedacumen[
Addrett(Num ran Sveet) ' Address(NUmberandStreet)
^ INCETON IN 47670
. Srnrg and ZIPCode liry. Srnte, and ZlPCade
E-mai/ Te E-mail
THESALESDISCLOSUREFORMMAYBEUSEDTOAPPLYFORCERTAINDEDUCfI0N5 HISPROPERTY. IDENTIFYALLOFTN HATAPPLY.
YFS NO CONDITION YES NO CONDITION
Q � 1. Will this proper[y be the buyer's primary Q ❑ 3. Homestead
residence? Provide comple[e address of prim Solar Pnr��+- ating/Cooling System
residence, including county:
6R F 2�+0 SOUTH ❑✓ 5. Wind Power Device
Addras(Numberand5trett) ❑ ❑✓ -6. HydroelecMc Power Device
PRINCETON IN 47670 GIBSON � Q 7. Geo[hermal Energy Hea[ing/Cooling Device
Ciry.smreZ Code Caunry
� 1� 2. Does the buyer have a homestead in Indiana [o be � ❑`� 8. Is this property a residenrial rental proper[y?
vacated for this residence? If yes, provide ❑ ❑✓ 9. Would you like to receive cax statements for this
complete address of residence being vacated, property via e-mail? (Provide rontactinformodon
including counry: below. Please see instrucdons for more informadon.
No[ovoilabl inallco/u��ndes.) Qa�
Addras (Number and Street) � � �a _ iq_ c�QO � [N�, � �
Theresa J Coomer NA
Ciry, Smre ZIP Lade County
Pdmarypmpe�ryownerconmRname E-mail
Under penalties of perjury, t hereby certify that this 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 6-1.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Drivers License/Other numbers are no[ �ecessary if no Homestead Deduction is
being filed.)
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Signamreo(BUyerl �/p / S{qnaNreo(Buyer2/Spause
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Las[SdigiuofBuyer2/SpouseDnver's Sm[e Last50igi[sofSocial5ecurity
Liwnse/ID/OtherNum6er Num6er License/ID/OtherNumber
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