Homestead_Elpers (41) •
INDIANA SALES DISCLOSURE FORM SDF ID: 2014 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)
Donald E. Harris
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1222 W 1200 St
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 ,
.
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and co to as required by I w, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
L
Signs ureof Seller--- Signature of Seller
onald E. Harris 9/16/2014 9/16/2014
Printed Name of Seller Sign Date(MM/DDNYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL IT AVAPPL-Yr C-'
Jacob Elpers I L l--1 =
ouyer 1-Rime as appears on conveyance document Buyer 2-Name as appears on conveyance document
500E Gibson St SEP 1 s 2014
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 ,
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION TES—I10.--CONDITION�
❑ 1. Will this property be the buyers primary ❑ 3. Homestead
residence? Provide complete address of primary 0 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
1222 W 1200 S
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
❑ 0 7. Geothermal Energy Heating/Cooling Device
;Haubstadt, IN 47639 I. Gibson 9y 9 9
City,State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ Does the buyer have a homestead in Indiana to be ❑ 0 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.
. • rntties.)
Address(Number and Street) . (o -. d - rot _3. 0O _ oo (. p ' O _ 0
I 9
City. State ZIP Code County —.Primary property owner contact name Em-'I
t