HomeMy WebLinkAboutHomestead_Kohlmeyer INDIANA SALES DISCLOSURE FORM SDF ID: 2013 Page 2
D. PREPARER .\
Kathy Masterson Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812) 425-0055 kathy@swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Jarod McNeil Moseley Tracy Ann Moseley
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2340 E 350 S 2340 E 350S
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 Princeton, IN 47670
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and com lete as required by law, and is prepared in accordance with IC 6-1. -5.5, "Real Pr/ perty Sales Disclo pre Act".
S. nature of Seller !/?/ ae%}.----
Sig ature of Seller / /'
J od McNeil Moseley _ 3 - IC-13 Tracy Ann Moseley 2 '/5 -1 3
Printed Name of Seller '`Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
YER(S)/GR TEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
,�(\\(\\Justin H. Kohlme r
Buyer I-N s appears on conveyance document Buyer 2-Name as appears on conveyance document
2763 S 450 E
Address(Number and Street) Address(Number and Street)
Francisco, IN 47649 ,
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDU s • FOR THIS PROPE- . P ENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION / YES NO CONDITION
"fir ❑ 1. WII this property be the buyer's primary -.-8- ❑ 3. Homestead
residence? Provide complete address of prim.s it r. • ... .. -rgy Heating/Cooling System
residence, including county:
❑ El 5. Wind Power Device
2340 East 350 South
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Princeton, IN 47670 i
i Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ El 8. Is this property a residential rental property?
❑ _6- 2. Does the buyer have a homestead in Indiana to be ❑ EI 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available i -all counties.)
Address(Number and Street)
— /71AP 4o_.U/ .3ds-- A, 7
City, State ZIP Code County Primary properly owner contact 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
information, Social Security and Drivers LicenselOther numbers are not necessary if no Homestead Deduction is being filed.)
- C/ _ -
Ign. re of Buyer 1 ? Signature of Buyer 2/Spouse
Justin H. Kohlmeyer )' J—/S—
License/ID/Other Number