Homestead_Stokes 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)
James T. Czoer
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
650 E 1025 S
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 a req ' d by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Gig
Sign re of ler Signature of Seller
J es T. oer 4/12/2016 4/12/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ''''''gggggg � 5 Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIF L�T /16
Preston S. Stokes 33-- nn�CC •
Buyer I -Name as appears on conveyance document Buyer 2-Name as appears on pggFrytr/te iga rent
46 E Oak St FF11�r
Address(Number and Street) Address(Number and Street)
Poseyville, IN 47633 ', , WIMP
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIO. -- •••PERTY. IDEN . • THOSE THAT APPLY.
YES NO CONDITION S NO CONDITION
X ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4. bo-rEnergy Heating/Cooling System
residence, including county:
9627 Winyard Place ❑ 0 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville, IN 47665 I Gibson' ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ Does the buyer have a homestead in Indiana to be ❑ 0 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 available in all counties.)
Address(Number and Street) 2 / —/ 7^O? V_aoT —l/^(6 do ' -oat ZIP Code County Primary property owner contact name E-mail