Homestead_Mersinger ," .
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2•D.PREPARER :,_t; _w_ r; ,, ,_ F a ' ': ;,-. ._ _='• . . "-;.cl-._. - -
ajChris Ferguson Closing Agent
i, Preparer of the Sales Disclosure Form Tide
MP 501 Main St.Ste 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) .i7.7-;a- z . .:.,} _ -. - `1-- '. . --, rt .
I aDonna C Dailey
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
!'
139of ar 4 4 learsel
Address(Number and Street 2-5- Address(Number and Street)
w0./I S II of e. Z
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 Fart,and i prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
,gn re of Seller Signature of Seller
I allnnna C 13ailPy /8-244 /2._
Printed Name of Seller Sian Date(MM/DOMYY) Printed Name of Seller Sion Date(MM/DD/YYYI
F:BUYER(S)/GRANTEE(S)`L APPLICATION FOR PROPERTY TAX DEDUCTIONS:-IDENTIFYALLITEMS THAT++"APPLY- - - .-
ichael J.Mersinaer
-----Buyaal•Name as apymrse nveyance document Buyer 2-Name as appears on conveyance document
109 S.4th Ave.
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 �YES� ND CONDITION
0 I±I❑ 1.Will this property be the buyer's primary ❑ 3.Homestea
residence? Provide complete address of primary ergy Heating/Cooling System
residence,including county: ❑
5.Wind Power Device
681 E Eisenhower Ln.
Address(Number and Street) ❑ Fl 6.Hydroelectric Power Device
Haubstadt IN 47639 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City.State ZI Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: r- _ . • -r : , tructions for more information.
Not available in all counne .
Address(Number and Street)
0, -14P - - _IQ - so . 03- O a s
City.State ZIP Code County
Primary property owner contact name E-rn ril