Homestead_Brown (2) 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)
Glenn Smith Construction LLC, an Indiana limited liability company '
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
357 E 750 S
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648
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".
A / I
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r Sic!ure of Seer 1l ` Signature of Seller
41,I )11 ( - )4-k 1fllp111\ma— 4/14/2016 4/14/2016
Printed Name of Seller I Sign Date(MM/DD/YYYY) Printed Name of Seller M/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YE NO CONDITION
❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ 4, Solar Energy Heating/Cooling System
residence, including county:
904 E Elm St. ❑ �A) 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson'
❑ $1) 7. Geothermal Energy Heating/Cooling Device
City St to ZIP Code County ❑ fcb 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 av-'-• - . - • -
Address(Number and Street)
d6 -/8- 36 - 41oo • too_ SQ--oo ,y
City,State ZIP Code County
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