Homestead_Hirsch (6) }
'INDIANA SALES DISCLOSURE FORM SDF ID: 2015 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)I GRANTOR(S)
Derik A. Matsel Melissa A. Matsel
Seller I -Name as appears on conveyance document Seller 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
Under/penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and omplete�s required by law, and is prepared in accordance with IC 6-1 1- .5, "Real Property Sales Disclosure Act".
L 4, , ;�. �'�'�
attire of Seller Signature of Seller
Derik A. Matsel 5/27/2015 Melissa A. Matsel 5/27/2015
' 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
Alexander J. Hirsch
.`'Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on conveyance do a
102 E Oak St 77. -46
2 Address(Number and Street) Address(Number and Street) y�
Fort Branch, IN 47648
1THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OE`, I +..7�.• •PPLY.
-.YES NO CONDITION YES NO CONDITION (/Njy7�•
9::i ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead Altj�/T
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Cooling System OR
residence, including county:
-504 North Main Street ❑ 2 5. Wind Power Device
Address(Number and Street) ❑ 2 6. Hydroelectric Power Device
;Fort Branch, IN 47648 I Gibson ❑ 2 7. Geothermal Energy Heating/Cooling Device
•F. City, State ZIP Code County ❑ E 8. Is this property a residential rental property?
—❑ i-' 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.
_7.1 Not available in all counties.)
Address(Number and Street) ' /
City, State ZIP Code County Primary property owner contact name E-mail