Homestead_Price (2) 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 i kathy@swinland.com
City,State,and ZIP Code Telephone Number 1 E-mail
E SELLER(S) 3RANTOR(S) �
Fred Mason Wilma Mason 1
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
600 S.Cumberland St. 600 S. Cumberland St.
Address(Number and Street) Address(Number and Street) '
Ft. Branch, IN 47648 Ft. Branch, IN 47648 1
Under pen hies of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and comp to asrequired by1 law, and is prepared in accordance with IC 6-1.1-5.5, ''ReallIProperty'Sales Disclosure Act".
LSignahfi "5f,"SSM�leddd SignatUre_of,Selle 1
Fred. son 10/17/2013 Wilma Mason 10/17/2013
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller I Sign Date(MMVDD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Peter Price
me as appears on conveyance document Buyer 2-Name as appears on conveyance document
222 S. Church St.
Address(Number and Street) Address(Number and Street)
Browns, IL 62818
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION .......YL$ NO CONrTION
❑ /1. Will this property be the buyer's primary ( 2S( ❑ r3. Homestea
1/4.1 residence? Provide complete address of primary ❑ El "4. o as r nergy Heating/Cooling System
residence, including county: I
❑ 0 5. Wind Power D��,�'I1
600 South Cumberland Street I Y..
Address(Number and Street) ❑ 6. Hydroelectric vre ffQIGSICiY/�.�J•
Fort Branch, IN 47648 Gibson ❑ 0 7. Geothermal Energy HCCeTTating/C99o��oling Device
City, ra IP Code County ❑ 0 8. Is this property a rementekenta property?
❑ /2 Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to re eive tax slat- en for this
vacated for this residence? If yes, provide complete property via-email?�t'to -�L'7 �f ct information
address of residence being vacated, including county: below. Please se: r I�.i' ■tyngormatfon.
Not availabQlf4r gith• e- .
Address(Number and S t r e e t) – /d - Z q{-ILO -o O/ /vo - o LC,
City,State ZIP Code County Primary property owner contact name E-mail