Homestead_Hornby 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) •
Charles F.Adamson Helen M.Adamson
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10867 S 350E 10867 S 350 E
Address(Number and Street) Address(Number and Street)
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 6-1.1- "Real Property Sales isclosure Act".
Signature of Seller Signature of Seller , . .
Charles F.Adamson • • • 7/15/2016 ' • Helen M.Adamson - 7/15/2016 ' -
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller n MM/DD/YYYY)
• F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL- MIT AT • -
hristieA. Homb> . . .
as appears on conveyance document Buyer 2-Name as appears on conve ee oct}n 1 b
5562 E 500 S' .
Address(Number and Street) Address(Number and Street) /1, n e��
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION - - - - ••,
❑ 1. Will this property be the buyer's primary ❑ 3 Homestead
residence? Provide complete address of primary ❑ oar nergy Heating/Coaling System
residence, including county:
204 N Main St. ❑ 0 5.• Wind Power Device
Address(Number and Street) ❑ 0 6._Hydroelectric Power.Device •
Fort Branch, IN 47648 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ E 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.
5c562..)-7--__-- 5-o0 S
•dress(Number and Street) / /
City, State ZIP Code County Primary property owner contact name E-mail