Homestead_Shoemaker INDIANA SALES DISCLOSURE FORM SDF ID: 2015 Page 2
D. PREPARER
Rocksan Underhill 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 rocksan @swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Doris J. Schmitt
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
608 W Church St
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
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".
(1 . _9 , , Ai-- -'7 /
ignature of Seller.'/ Signature of Seller
Doris J. Schmitt 10/15/2015 10/15/2015
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
Bradley Shoemaker
Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on conveyance d en
425 Coronado Dr
Address(Number and Street) Address(Number and Street)
Mt Vernon, IN 47620 QC,. ...ea
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OP PPLY.
YES NO CONDITION YES NO CONDITION NT
El ❑ 1. Will this property be the buyer's primary ❑ ❑ 3. Homestead k 4 0
00.
residence? Provide complete address of primary ❑ p 4. Solar Energy Heating/Cooling System 0I'
residence, including county:
608 W Church St. ❑ 2 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
H
aubstadt, IN 47639 Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ a 8. Is this property a residential rental property?
❑ 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.
Not available in al ounties.)
Address(Number and Street) a/ / q
City, State ZIP Code County Primary property owner contact name E-mail