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INDIANA SALES DISCLOSURE FORM SDF ID: 2015 Page 2
D. PREPARER
.1 Kathy Masterson Escrow Officer
Preparer of the Sales Disclosure Form Title
i 605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
i Address(Number and Street) Company
il Evansville, Indiana 47713 (812)425-0055 kathy @swinland.com
:i City. State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
SARA L KIXMILLER
Seller I -Name as appears on conveyance document
Seller 2-Name as appears on conveyance document
1
i Address(Number and Street) Address(Number and Street)
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i 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".
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Signature of Seller Signature of Seller
SARA L KIXMILLER
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
I Benjamin F. Kixmiller
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
5797 N State Rd 65
Address(Number and Street) Address(Number and Street)
Hazelton, IN 47640 ,
THE HE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY MA r6F$ra45AT APPLY.
YES NO CONDITION YES NO CONDITION
I 0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead I. i
residence? Provide complete address of primary `prig►,
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residence, including county: ❑ 0 /4 Solar Eng�t{q( i ry gull � R
6797 N State Road 65
❑ d 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Hazleton, IN 47640 Gibsori ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 0 2. 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.
• Not available in all counties.)
. Address(Number and Street)
c17-0h o&-3ov-ooa. ?s970J7
1 " Primary properly owner contact name
City. State ZIP Code County rYP P Y j E-mail
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