Homestead_Mulvaney ••- INDIANA SALES DISCLOSURE FORM SDF ID: - Y. 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) -
Tod D. Doss Jennice N. Doss
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2107 Presley Lane • 2107 Presley Lane -
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 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 6-1.1-5.5, "Real Property Sales Disclosure Act".
T 9 Q/`i,c `� 1,�.tivL�==v1,mm
r natur of Sner /_ `°Suture of Seller 4/
Tod D. Doss - '.60/ 1/ ?O(YJ Jennice N. Doss 0 7I/OI mil(_
Printed Name of Seller _ • Sign Date(MM)DO/YYYY) Printed Name'of Seller Sign Date(MM/DDIYYYY)
F.—BUYER(S)/GRANTEE(ST-APPLICATION-FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALLMEM'®tS PAT'�PPLY
. Kevin L. Mulvaney _ Michelle L. Mulvaney I ° J'
t • Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
• 8602 Burch Park Dr 8602 Burch Park Dr AtiI b = 2016
Address(Number and Street) Address(Number and Street) t�
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY:IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION /4E5 NO CONDITION
�, ID 1. Will this property be the buyer's primary ❑ 3. Homestead
1 residence? Provide complete address of primary 0 4. Solar Energy Heating Cooling System
residence, including county: . •
❑ 0 5. Wind Power Device
2107 Presley Lane
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
rHaubstadt, IN 47639 Gibson' ❑ 0 7. Geothermal Energy Heating/Cooling Device
ty, State ZIP Code County ❑ 0 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
ddress of residegce being v ted, including county: below. Please see instructions for more information.
71'09\ -/2U `T /L r y„ 1, 7r Not available in all counties.)
Address(/Numberand treet) !-1.q C� � Y- /6frifi a c_ aa- I to- aoo _co'' 9 -oa t /
'���of / � �� Primary property owner contact name - 7E-mail I
City,State ZIP Code County