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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 (812)425-0055 kathy@swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Robert D. Winchel Brenda K.Winchel
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
38171 W 231 St 38171 W 231 St
Address(Number and Street) Address(Number and Street)
Wellsville, KS 66092 Wellsville, KS 66092
City,State,and ZIP Code City, State,and ZIP Code
Telephone Number 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".
Signature of Seller Signature of Seller
Robert D.Winchel 2/8/2016 Brenda K.Winchel 2/8/2016
Printed Name of Seller Sign Date(MM/DOfYYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Kelly P. Haley Lori A. Haley
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
402 S West St 402 S West St
Address(Number and Street) Address(Number and Street)
Habustadt, IN 47639 Habustadt, IN 47639
HE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APP
YE NO CONDITION YES NO CONDITION
❑ Q%Will this property be the buyer's primary `� ❑ -3 Homestead FILE
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
545 W State Road 68 ❑ 0 5. Wind Power Device FEB 10 2016
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson ❑ 0 7. Geothermal Energy H� vice
City,State ZIP Code County ❑ 0 8. Is this property NitilattteTd'rd rt'y'?'r't
❑ )2..Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
L...-- 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 all counties.)
Address(Number and Street)
c3" 113 .3b- tiO3-OW. I S 9 coct
Ciry.State ZIP Code County rimary property owner contact name -mail
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