Homestead_McCarthy (2) 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)
Estate of Jacquline M Cox
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1505 E Co Rd 375 S
Address(Number and Street) Address(Number and Street)
Winslow, IN 47598
•
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and complete/ j�
as required by law, and is prepared in accordance-with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
cSignature of Seller ' -- r Signature of Seller
5/26/2016 5/26/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ign Date(MM/DD/YYYY)
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 CONDITION
❑ 1. Will this property be the buyer's primary ' ❑ 3. Homestead
residence? Provide complete address of primary 0 0 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
319 S Gibson Street
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Oakland City, IN 47660 Gibsori ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 1.0 2. 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)
Z 10-/9- 1 -3!o3 Coo a%O 007
City, ZIP Code County Primary property owner contact name E-mail
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