Homestead_Chapman INDIANA SALES DISCLOSURE FORM SOF ID: 2016 Page 2
D. PREPARER
Rocksan Underhill Escrow Officer
Preparer of the Safes 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 rocksan @swinland.com
City,State, and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Roger W. Zenthoefer
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
114 S Damosa Dr
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 c lete as required by law, and i prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Yca . La...mo
Signatu fl eller ---- Signature of Seller
Roger W. Zenthoefer 12/2/2016 12/2/2016
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ������------'''TT'tttt gg tltl Sign Date 1(MMM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL I SIH @T A ;J
Jo aDavid Chapman Jodie Rae Chapman ¢¢
_ on conveyance document Buyer 2-Name as appears on conveyag6e,doµrperl(O,c
1916 Haven Dr 1916 Haven Dr UU CC IL. VV I/ LL llll
Address(Number and Street) Address(Number and Street)
Evansville, IN 47711 Evansville, IN 47711
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
ES NO CONDITION --
��I{ ❑ 1. Will this property? Pro be the complete buyer's primary ( 4. Homestead
residence? Provide complete address of prima , q rota - gy 'eating/Cooling System
residence, including county:
114 S Damosa Dr. ❑ [0 5. Wind Power Device
Address(Number and Street) ❑ p 6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson ❑ ?EC-7. Geothermal Energy Heating/Cooling Device
. City State ZIP Code County ❑ (B8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 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.
/9/ 6 lick veil I der Not available in all counties.)
Address(Number and Street) r✓
(,vc,.,,sc.lic- IN `f "-17 \ ( 016 -78-3ip - 4o3 —too. (308 ,00511
City, State ZIP Code County Primary property owner contact name E ail
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