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INDIANA SALES DISCLOSURE FORM SDF 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)/GRANTOR(S)
Lacey A. Bertram
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
302 N Church St
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648
.
/(J�—/ P,(fr1_A . I
Signature of Seder Signature of Seller
Lacey A-Bertram 6/17/2016 6/17/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller gg TTTT Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY A f tstiATf Pt
Austin Q. Martin @@ c��c flfl
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conJ UIV G / CU le
2421 W 1025 S .JUIV L f CU
Address(Number and Street) - Address(Number and Street) nn,,
Fort Branch, IN 47648 �fj7p
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 ❑ El 4. Solar Energy Heating/Cooling System
residence, including county:
❑ El 5. Wind Power Device
302 N Church St.
Address(Number and Street) ❑ El 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ ❑ 7. Geothermal Energy Heating/Cooling Device
City,Stat IP Code County ❑ 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ El 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)
(O- iq-1 (2- 301 -oar . Racca4
City,State ZIP Code County nary property owner contact name E-mail