Homestead_Jackson •
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INDIANA SALES DISCLOSURE FORM SDF ID: 2015 Page 2
D. PREPARER
Kathy Masterson Escrow Officer
Preparer of the Sales Disclosure Form Title
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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)
James T. Czoer dba Czoer Construction
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
650 E 1025 S
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
Under penal "es of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
of dl;conhp a as requi d by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". • ---
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10/15/2015 gnawre of S Signature of Seller — -
10/15/2015
• .;Pr•nted.Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ..a C,• a D/YYYY)
.F.:BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL I it Si ;T A ' :Y ',. c t
i ( ,• I
c. .
annon H.Jackson • -- --
° r. • --- . "ppears on conveyance document Buyer 2-Name as appears on conveyanWydpct(q�tgt 2015 -
8332 Southport Dr UU II �I 6111 C
'-'Address(Number and Street) Address(Number and Street)
Evansville, IN 47711 J
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. -.
-YES NO CONDITION Y N --
I ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestea
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
• ❑ 0 5. Wind Power Device, -
908 W Elm St. ❑ 0 6. Hydroelectric Power Device
- Address(Number and Street)
laubstadt, IN 47639 I Gibson
❑ 0 7. Geothermal Energy Heating/Cooling Device
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
- 1 vacated for this residence? If yes,provide complete property via-email? (Provide contact information
. =' ddress of residence being vacated, including county: •e ow. Please see •.s for more infornation.
ti-tt _ T ✓ Not available in all counties.)
.-.Adtl ss(Number an Stre ) v
i( s �l//e IN .efl7rfi' .6 -R8- 3 4 - Yao -ooD- 690 -0e
-City,State ZIP Code County
•mary property owner contact name E-mail