Homestead_Rogers (2) INDIANA-SALES DISCLOSURE FORM SDF ID: 2013 Page 2
b. PREPARER
Sherri Hudson • Closing Agent
P'°oarer of the Sales Disclosure Form
0 Title
E E Martin Luther King Jr Boulevard Southwestern Indiana Land Title
adress(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 sherri@swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
William E. Smith, Jr. Cynthia S. Smith
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
155 E. 795 South 155 E. 795 South
Address(Number and Street) Address(Number and Street)
Ft. Branch, IN 47618 Ft. Branch, IN 476¢8
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and c•mp>I`c as requr by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".•
b Signa�j-of Seller 0- Sighature ofS�er /
William E. Smith,Jr. o3054t/3 Cynthia S. Smith 4 / 15113
13
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Da.e(MPneibbD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
-
Jason Rogers Christine Rogers
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
2 ouch Race Street 922 South Rae Street
ess(Number and Street) Address(Number and Street)
Princeton, IN 47670 Princeton, IN 47670
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
❑ 1. Will this property be the buyer's primary C 11 /a Homestead
residence? Provide complete address of primary ❑ B 4. Solar Energy Heating/Cooling System
residence, including county:
❑ q/5. Wind Power Device
155E795S
Address(Number and Street) ❑ o6/' Hydroelectric Power Device
Fort Branch, IN 47648 i Gibson' ❑ Yy Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ B' 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
n address of residence being vacated, including county: below. Please see instructions for more information.
2-22- S to 9i / .4 -i Not available in all counties.)
Address(Number and Street)
prt,,cd-„ iitJ q;-&;o C,tl,>soN, aca-ict-IS - ad3 -00 . a( V-b 6
City,State ZIP Code County Primary property owner contact name E-mail