Homestead_Dewig (10) INDIANA SALES DISCLOSURE FORM SDF ID: 2016 Page 2
D. PREPARER
Teresa S. Holifield 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 teresa @swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)I GRANTOR(S)
Hannah R. Schafer
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
690 E Eisenhower Ln
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
an complet as required by flaw, a is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
CI
ignature of Seller /,-- `� A. Signature of Seller
Hannah R. Schafer 11/15/2016 11/15/2016
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
Keith A. Dewi Christie M. Dewig • D
- -B ame as appears on conveyance document Buyer 2-Name as appears on co an e p
203 W Maple St 203 W Maple St NOV Address(Number and Street) Address(Number and Street) NOV 1 7 2016
Haubstadt, IN 47639 Haubstadt, IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION TION
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homeste
residence? Provide complete address of primary - 0 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
690 E Eisenhower Lane
Address(Number and Street) ❑ Z 6. Hydroelectric Power Device
Haubstadt, IN 47639 i Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,St ZIP Code County ❑ 0 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.
Notavai-• - • - • • -
Address(Number and Street)
M-/(1-3a - /ID/ - edO. 790 -en.
City, State ZIP Code County Primary property owner contact name -mail