Homestead_Blankenberger (5) INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Kathy Masterson Esaow 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 ZIPCode Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Michael L. Clark Jana L. Clark
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
4501 E 1150 S 4501 E 1150 S
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 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 by law, and is prepared in accordance with IC 6- .5, "Real Prope•• Sales Disclosure Act".
Signature of Seller Signatu-- of Seller
Michael L. Clark 5/26/2016 Jana lark 5/26/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MMIDD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
(Kelsey A. Jace A. Blankenberger
u e as appears on conveyance document Buyer 2-Name as appears on conveyance document
4201 Schroeder Rd 42C1.1---Sdar n�der Rd_ /ON-7 5 39 6
Address(Number and Street) Address(Number and Street)
Evansville, IN 47725 / Jg57A D T iN +1 b 39
((
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 a - ••
❑ 1. Will this property be the buyer's primary , a. ❑ 3. Homestea•
residence? Provide complete address of primary ❑ Er 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
4501 E 1150 S
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
,Haubstadt, IN 47639 ( Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
tty,State ZIP Code County ❑ u 8. Is this property a residential rental property?
❑ 2. Does the bu buyer have a homestead in Indian b II L-y--1 r'' • Would you like to receive fax statements for this
vacated for this residence? If yes,provide cjmpll e 9J I property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
(Oi 3 35.0 & JUN 2 2016 N o . - ' .acounttea.
Address(Number and Street)
t-f7 J(sT/-rw• //J `nat3 .zG-.7-.3-/a .J00 _000. 3ES -0d,y
City,State ZIP Code
County It • '-1 'i4'YS•ertl, ,•ct-aame
O=D°ON C4►IInITV AUDITOR