Homestead_Brasher INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Teresa S. Holifield Escrow Officer
Preparerof 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 @swinland.com
City State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
James T. Czoer
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
650 E 1025 S
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 - re• ired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
/
/Nina ure of her' r Signature of Seller
James l. Cz•-r 1017/2016 10/7/2016
./Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Kyle Brasher Kristin Brasher tt����!!pp
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance ee�n t
502 E John St 502 E John St
Address(Number and Street) Address(Number and Street) j�
Fort Branch, 47648 Fort Branch, IN 47648 �7/'`
, ��/
❑ 1. Will this property be the buyer's primary [ ❑ 3. Homestead q
residence? Provide complete address of primary
residence, including county: ❑ 4. Solar Energy Heating/Cooling S ys7t ,
❑ 5. Wind Power Device
1300 W Hunters Crossing
Address(Number and Street) ❑ 6. Hydroelectric Power Device
.Haubstadt, IN 47639 ' Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
rty, State ZIP Code County ❑ t! 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 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.
So , .{-5 f i ),, Not available in all counties.)
;Address(Number and Street)
4 .(2)(6NICP4 y000VC 6r13s-1N- Za-/8-`3 :30o 000 . ,o to -oay
City State ZIP Code County Primary property owner contact name E-mail