Homestead_Simmons (2) INDIANA SALES DISCLOSURE FORM SOF ID: 2016 Page 2
D. PREPARER
Kathy Masterson Escrow Officer
Prepare(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)/GRANTER(S)
Sonja Sides .
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
505 N West St
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:is required by law, s prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
yl eGFi
SSStitggnatureoof ller. . } Signature of Seller
Sonja Sides 4 6/9/2016 6/9/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Jesse A. Simmons _
Buyer 1-Name as appears on conveyance document • B er - 'am- as appears on c17-11- c;•ocu •
94-go s as VD .
Address(Number and Street) Address(Number and Street) _ •
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDEBTWYABB OP.TlN)$E\THAI`APFI3:'
YES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary Q ❑ 3. Homestead
residence? Provide complete address of primary /❑ p 4. Solar Energy Heating/Cooling System
residence, including county:
❑ El 5. Wind Power Device
505 N West St. ❑ a 6. Hydroelectric Power Device
Address(Number and Street)
Fort Branch, IN 47648 Gibson' ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ EI 8. Is this property a residential rental property?
❑ 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) a! - 1 S- ( `1^ Lt O ( - Oo e1 1 ^� j Co
City,State ZIP Code County Primary property owner contact name LbE-mail