HomeMy WebLinkAboutHomestead_Osmer 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
l
City, State,and ZIP Code Telephone Number E-mail
l E-SELLER(S)/GRANTOR(S)
James T. Czoer dba Czoer Construction
' Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
650E 1025 S
i Address(Number and Street) Address(Number and Street)
I 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
Iand complete as requir by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Ifof Seller / „ I t(4- f v-tn-A--. ----, . , Signature of Seller
Kfl2A.&S I w WL 4" r Lob a j Ol o&Om f Sign Name of Seller Sign Date M/DD/YYYY) Printed Name of Seller Sin Date(MM/DD/YYYY)
I F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Shane Osmer Carrie Osmer
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
8186 Hwy 87 N 8186 Hwy 87 N
Address(Number and Street) Address(Number and Street)
Timpson, TX 75975 Timpson, TX 75975
r
I THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY AL OFT Oit THAfiAPP
YES NO CONDITION YES NO CONDITION
El ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead 0 I 7 2014
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Cooling System
residence, including county:
❑ El 5. Wind Power Device
1272 West Chukar Hollow ❑ p 6. Hydroelectric P r ce 1 "--' ,
Address(Number and Street) Y �� W OUNTYAUD:TOR
'Haubstadt, IN 47639 i Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ ❑ 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
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
a(o— Ig36-3oo-o®a,. 60a\-oaf
City, State ZIP Code County Primary property owner contact name E-mail