Homestead_Schafer INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Teresa S. Holifield 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 teresa @srrinland.com
City.State, and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Wayne King
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
5525 Highway 63 South - .
Address(Number and Street) Address(Number and Street)
Rochester, MN 55904 ,
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".
S'wW, l
"Sig lure of Selle • Signature of Seller
Wayne King �[�
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of SeDULY EN I EKED FOR TP.S�,'.,��ynt�i�7aN (MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDEfgj�YcAtb(IlIONIScci a. XtPPLY H �,
Detrix A. Schafer Hannah R. Schafer—day of -----
Buyer I-Name as appears on conveyance document Buyers 2-Name as ap ears on conve r�c< e- umen• ditor
69 of/ e /$Plr1 bode, C1- y O e ' : �t %c WICI n County
Aydreess(Number and Street] Ad ress(Number reef)
1 6:5274-i r .ry.) 1-17623 Ci "
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS F TY. IDENTIFY ALL OFJU $T
SHAf yn6LY.
YES NO CONDITION ES NO -C6NDITION
`R ❑ 1. Will this property be the buyers primary i C ❑ 3. F{pmestaa
residence? Provide complete address of primary ❑ 4. Solar Energy e
residence,including county: / Device
�� A�IDITOR
2250 E 600 ❑ LAY 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Fort Branch, IN 47648 j Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ t{8. Is this property a residential rental property?
4 ❑ 2. Does the buyer have a homestead in Indiana to be ❑ k- 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
r C- 1.---/address of residence being vacated, including county: below. Please see instructions for more information.
t 1' 0 (.FNh Alder L Gnle— Not available in all counties.)
Address(Number and Street)
t"I 13S pc-6 (-(7G3 i Cci I_95�� (P -K'-O 9-doo co a 3 8 -bps
City, State ZIP Code ' County Primary property owner contact name E-mail