Homestead_Spells INDIANA SALES DISCLOSURE FORM SDF ID: 2016 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 (
E-mail
E.'SELLER(S)/GRANTOR(S)
Richard Smith
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
- 12860 S Sunset Dr
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
)City, State,and ZIP Code City, State,and ZIP Code
O4
E-mail Telephone Number E-mail • "
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".
c eP
Signature of Seller Signature of Seller
Richard Smith 1/5/2016 Ng (�
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller + I Sign ( / ;�/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPL
Jason L. Spells Chandra N. Spells JAN 8 2016 .-
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
-2532 Lincoln Ave 2532 Lincoln Ave n[ :
Address(Number and Street) Address(Number and Street) GIBSONCOUN
Evansville, IN 47714 Evansville, IN 47714 TY AUDITOR
City, State,and ZIP Code City, State,and ZIP Code
E-mail
TILE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary % ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
556E 200 N
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
1Princeton, IN 47670 i Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 0 8. Is this property a residential rental property? •
❑ `fJ2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
l 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.
Address(Number and Street)
..7 6 -0S- 32 . loo - 000 . 363 -o A7
City, State ZIP Code County _Prima ry property owner contact name E •-il