Homestead_Matsel (4) .i
INDIANA SALES DISCLOSURE FORM SDF ID: 2015 Page 2
D. PREPARER
1
Kathy Masterson Escrow Officer
, Preparer of the Sales Disclosure Form Title
•`605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
'n Address(Number and Street) Company
• i•1•
Evansville, Indiana 47713 (812)425-0055 kathy @swinland.com
:.: City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
-Larry Sprinkle Ellen Sprinkle
S Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
603 S Eastview 603 S Eastview
- Address(Number and Street) Address(Number and Street)
• Fort Branch, IN 47648 Fort Branch, IN 47648
.
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 re ' d by law, andFis repared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
-: ignature of ' le • ' / 'Signature of Seller
-t /
1 ,Larry Sprin le 5/28/2015 Ellen Sprinkle 5/28/2015
: ::-..t Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
i•F: BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Derik A. Maisel Melissa A. Matsel
-' Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
504 N Main St 504 N Main St
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
"THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONSfrOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA' •-PLY.
'YES NO CONDITION YES NO CONDITION MAY 29 2015
-is ) ❑ 1. Will this property be the buyer's primary r. ❑ 3. Homestead
4 residence? Provide complete address of primary 0 4. Solar Energy Heat' /Cooli S tem
residence, including county:
;1 ❑ O 5. Wind Pow Devi
•603 South Eastview Street LIBSON CDUNTY AUDITOR
:-.'Address(Number and Street) ❑ 2 6. Hydroelectric Power Device
-Fort Branch, IN 47648 Gib nso ❑ 0 7. Geothermal Energy Heating/Cooling Device
-7 City, State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 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.
"gin, • hi p p S Not available in all counties.)
• Address(Number and Street)
ME1— R(�-nal—( /1/ Cy , &.`--r3 a- 19-/9-/o1- 0oo. e - -0, (.0
,y, State ZIP Code County Primary property owner contact name E-mail
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