Homestead_Ward 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)
Anthony D. Hallam Dana J. Hallam .
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1843 E Sierra Dr 1843 E Sierra Dr
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 _ Haubstadt, IN 47639
Under penaltie • •- - -• ertify that this Sales Disclosure)to the best of • knowledge and belief, is true, correct
and comp), - as required by law, and - prepared in accordance with •-1.1-5.5, ••' P - •erty Sales Disclosure Act...
a 'arAn 1 ' I L--
• Sig ature o •Tgnature of Seller' -may
Anthony i. _ .-- f / Dana J. Hallam i3/on% /3 6
Printed Name of Seller Si. Date(MM/DD/YYYY) Printed Name of Seller ;— _i•. •-te(14 D/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY AL S I >- °' Z
Rick D.Ward
- - -s appears on conveyance document Buyer 2-Name as appears on conM cerdffu�fC ,
11692 E State Rd 445 11 VV �Ill1l
Address(Number and Street) Address(Number and Street)
Bloomfield, IN 47424 ltr1Y/1l
THE 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--CONDIILON
❑ 1. Will this property be the buyer's primary ❑ 3. Homestea
• residence? Provide complete address of primary Sutra nergy Heating/Cooling System
residence, including county: "` 777""""'
❑ Si 5. Wind Power Device
1843
(Number and Street)d E Sierra Dr. El 'Q 6. Hydroelectric Power Device
A
Haubstadt, IN 47639 I Gibson ❑ & 7. Geothermal Energy Heating/Cooling Device
\P./City,State ZIP Code County ID $71. 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.
ii kg? L S jm-re-_ 4i 4�S Not available in all counties.)
ddress(Number and Street) K-1 •
Loom. c( et,A 7 ri ii--)LK)- >` (;-r_ 4, - 2 ,3- (ti too - oat - a b 9-0a y
City, State ZIP Code County Pnmary property owner contact name E-mail
•