Homestead_Wilson (12) 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)
Beth Ann Kruse
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
317 S Race St
Address(Number and Street) Address(Number and Street)
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
Beth Ann Kruse 5/18/2016 5/18/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller n• I.to(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALLEES�HATP ¢ 1
Colton W.Wilson 999999 999999
u8J N - 5 E as appears on conveyance document Buyer 2-Name as appears on con Iqi I G 3uLU16
2189 N 575E IVIF11 6 J Co O
Address(Number and Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES ' NO CONDITION Y�S�*G—GONOLIIQN
tQ ❑ 1. Will this property be the buyer's primary �� ❑ 3. Homestea
residence? Provide complete address of primary "�J 4. solar tnergy Heating/Cooling System
residence,including county:
317 S Race SL ❑ 1 5. Wind Power Device
Address(Number and Street) ❑ ,^6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson- ❑ r.1? 7. Geothermal Energy Heating/Cooling Device
City, tat ZIP Code County ❑ 8. Is this property a residential rental property?
0 2. Does the buyer have a homestead in Indiana to be ❑ X19 Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete r property via-email? (Provide contact information
address of residence being vacated, including county: below - -. - -- '. ctions for more information.
of available in all counties.)
Address(Number and Street)
•01 , - /9.33!- 30.3 _ 000 . 3y3 _009
Ciry,State ZIP Code County (primary property owner contact name E- •.