Homestead_JacksonINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Karen Harbison VP
�Preparero/the5a7aDudosvreForm Title
803 E State Rd 68 Elberfeld Siate Bank
Addras (Numberand Stree[J
Cin; S:n:e, nnd ZI➢Ca1e Tdephone Number E-moil
iE�:=SEL•LER S ' GRANTbR S - � � ` �'" - �= �{�,�� �; .. -r*• � � �.'�!-'�
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Se//er 1- Nome as appears on ronveyanre davment Se(!er I- Name as appmrs w ronveyancedo[vment
110 W Inglefield Rd
Add�as (Nvmber and Street) Addrets (Number and Strre[)
Evansville IN 47725
Tele honeNVmber £�mail Tele honeNUmber Email
Under e� al[ies of� �ju , 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is [rue, correct
and ete as re'aui d by law, and is prepared in accordance wi[h IC 6-1.1-S.S, "Real Proper[y Sales Disclosure Act".
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Signa[ureof5el! r SignaNreofSeller
Stacv Isaacs 07/18I2012
PnnledNameo Seller SiqnDate MM/DD RinfedNameo Sel/v Si nDate MM/DO
�F�BUYER S `.GRANTEE S� .�ARPLIGATION)F,OR?P,ROPERTY�TAX�DEDUCTIONS'.11DENTI ,F,1'?ALiL'�ITEhiS;THi�T�APP.I:Y��z„-,n-��^.��_,�`���'�
Stefan C Jackson Brittany L Eloers
Buyel 1� Name as appears on ronveyanre dorument Buyer I� Name as appmrs om m�veyantt da'umm[
102 Ben Street Aot 5 10143 S 240 W
Address (Num6erund Street) Address (A'vmber ond SveeQ
� Haubstadt IN 47639 Fort Branch. IN 47648
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THE SALFS DISCLOSURE FORM AIAY BE USED TO APPLY i0R CERTAIY DEDURIOYS FOR THIS PAOPERN. IDEYTIFY ALL OF THOSE THAT APPLY.
Y'FS YO COYDITIO.�' I YFS NO CONDITIOY
� ❑ 1. lNill this property be the buyer's primary Q ❑ 3. Homestead
residence? Provide complete address of primary � Q 4. Solar Energy Hea[ing/Cooling System
residence, including county: � �
5. Wind Power Device
2619 W 7025 S
Addrus(A'umberundSVee[) ❑ 0 6. Hydroelectric Power Device
Ft Breneh. IN 47648 � � 7. Geo[hermal Energy Heatlng/Cooling Device
CiN. Smle ZIP Code Counry
❑ Q✓ 2. Does the buyer have a homestead in Indiana to be � � 8• �s :his property a residential ren[al property?
vacated for this residence? If yes, provide ❑ 0 9. Would you like to receive tax statements For this
complete address of residence being vacated, property via e-mail? (Provide contoct in(ormotion
induding county: below. Please see instructions for more in(ormation.
Not available in all counties.)
Addre[s (Nvm6er and Street)
aa-iS-3� y0000a aa5�a5�
[iry. smreZ/PCode [ounry
Pn'maryproperryownerronmc[name E-mail
Under penalties oF perjury, I 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 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informatio Social Securiry and Driver's License/Other numbers are not necessary if no Homes[ead Deduction is
beinp file .� n � /� /, /l n�
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