Homestead_Cooper (3) 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
CI E:-°SECL•ER(S)./..GRANTOR(S) ,
Jason A.Vanden Brook Penni J.Vanden Brook
Seller t-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
315 S Prince St 315 S Prince St
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
Under pen. ties of perJjury, khgg eby certify - is/Sale I iscl•-ure,t• t - best of my knowledge and belief, is true, correct
a d corn• dared by 16w, and is pr •- -d/in a o
` e with I , 1.1-5.5, "Real Property Sales Disclosure Act".
iis - ( / .`rte lDl�=y_° ;.�� f - fr �. tom 'P�'
z a'.^Sig�..'r oT Seller ;,1 ���1 rr `-Sig . urebf Seller fl
J on-A •.eden-Br.o \ /1-R•. • •enni J. anden Brook 7/15/2016
ET(//Printed.Name orSSeller • .� Sign Date(MM/DD/YYYY) Printed' ame of Seller Sign Date(MM/DD/YYYY)
t :•BUy R(S)IGRANTEE(S APPLICATION FOR PROPERTY TAX DED. - - 45 -IDENTIFY ALL-ITEMS THAT ;
othy M. Cooper Karla M. Cooper
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document '
624 S Mohican Dr 624 S Mohican Dr lip/�
Address(Number and Street) Address(Number and Street) LI
Patoka, IN 47666 - Patoka, IN 47666 0/4 ■4 . eft
/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT A4V¢Y
YES NO CONDITION YES NO CONDITION 04,
"Q) ❑ 1. Will this property be the buyers primary iiW ❑ 3. Homestead
residence? Provide complete address of primary ❑ a 4. Solar Energy Heating/Cooling System
residence, including county:
El El 5. Wind Power Device
315 S Prince St.
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Princeton, IN 47670 ! Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ El 8. Is this property a residential rental property?
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) a ' /02-62 Sod_O6/ J o oS J s r7
City,State ZIP Code County Primary property owner contact name E-mail