Homestead_Lewis 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, SELL'ER(Sy/GRANTOR(S)
_Mildred L. Burns
Seller I -Name as appears n conveyance document Seller 2-Name as appears on conveyance document
/g �/� er /00 S -
e.AddressT "Sefr'-nd�8tmet)��' / Address(Number and Street)
-_
Telephone Number 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".
$ignet�otSille( Signature of Seller
Mildred L. Burns /Cl3
Printed Name of Seller gn:Date(MYvYDD/YYYY)—- Printed Name of Seller Sign Date(MM/DD/YYYY)
(F.-BUYER(S)IGRANTEE(S)'-APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Tege E. Lewis Tricia D. Lewis
Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
2804 Monroe Ave 2804 Monroe Ave
Address(Number and Street) Address(Number and Street)
Evansville, IN 47714 Evansville, IN 47714
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
4 ❑ ( Will this property be the buyers primary ❑ C3. Homestead
v residence? Provide complete address of primary ❑ E `q Solar Energy Hea /C oli g System ','"'-
residence, including county: I t--; ': '∎1
❑ ID 5. Wind Power Dev 1L� ; t.
10845 E CR 100 South
Address(Number and Street) ❑ I 6. Hydroelectric Power vice
Oakland City, IN 47660 Gibson ❑0 7. Geothermal Energy Xg ]o1Device
City, State ZIP Code County ❑ l 8. Is this property a resi.- tial rental property?
' ❑ Does the buyer have a homestead in Indiana to be ❑ l 9. Would you lilf¢,)p te.�r;•..r Ty;1;jj-n s or this
vacated for this residence? If yes, provide complete property via-e-Hin.TPtParetlewra9Aft jgftrmation
address of residence being vacated, including county: below. Please see instructions for oit'i9ftrmation.
-a// 17 Are-
. available in all counties.)
Address(Number and Street)
Z7vti-
E1 a-40-1 i/fn,/ rN. V 7 2/V I 4r,4/1.r, dro-l3-13-300-601.Soo-0010
\ City. State ZIP Code v County 'primary property owner contact name E-mail
1 _
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, Security and Driver's License/Other numbers are not necessary if • Homestead Deduction is being filed.)
Signatureobellyer-1...43 `.nature of r_ pouse -
Tege E. Lewis 0s�/Q a0�3 Tricia D. Lewis �O1I3