Homestead_Sexton INDIANA SALES DISCLOSURE FORM SDF ID: 2016 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)
Mr BB, Inc., an Indiana corporation
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
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„byylaw, and is prepared in accordance with IC 6-1.1-5.5, 'Real Property Sales Disclosure Act".
-GLLt .5-ntA .I 12001!
gnature of Sefn 1 Signature of Seller
Richard W Smith, fry de(lb 2/26/2016 2/26/2016
Printed Name of Sel eery' Sign Date(MM/DD/YYYY) Printed Name of Seller TS i tErftiDD/YYYY)
F. BUYER(S)IGRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITE T A APP �}r�
Shane P. Sexton) Amber M. Sexton n.
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyancf(9ut2ebt 1016
78" E 7.CO s
Address("wither and Street) // Address(Number and Street)
, IN roil if rnePr l'1 7 7`Yd�/ , IN
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
PEES NO CONDITION YES/' Ito—CBN8Fi76N�
❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ izo 4. Solar Energy Heating/Cooling System
residence, including county:
501 E Mulberry St. ❑ A) 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
!Fort Branch, IN 47648 1 Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ /J )8. Is this property a residential rental property?
❑ l� /2. Does the buyer have a homestead in Indiana to be ❑ � 9 Would you like to receive tax statements for this
V 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 avail.. - '. - • • '-
Address(Number and Street)
o2t - 19 -/ 9-/0/ - boo , 774 -off
City,State ZIP Code County =maWproperty owner contact name E-mail