Homestead_Hisch INDIANA SALES DISCLOSURE FORM SDF ID: 2017 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)
Richard W. Smith Monica Smith
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12860 S Sunset Dr 12860 S Sunset 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 co plete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disal•s e Act".
G- ccL t, 4--- 'Ma& - : �i
Signature of Seller Signature of Seller
Richard W. Smith 1/10/2017 Monica Smith 1/10/2017
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 A H• , •PPLY-• .
I I r l
• tephen W. His , i I.•
• Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance docume-
109 S 4th St JAN 11 2011
Address(Number and Street) Address(Number and Street)
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 ///''' � NO CUNLATIONN
❑ 1. Will this property be the buyers primary ( ❑ 3. Homestead
residence? Provide complete address of primary \ ' ❑ 0 4. o ating/Cooling System
residence,including county:
426 S West St. ❑ 9 5. Wind Power Device
Address(Number and Street) ❑ 9 6. Hydroelectric Power Device
'Haubstadt, IN 47639 I Gibson ❑ a 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 9 8. Is this property a residential rental property?
❑ 19 2. Does the buyer have a homestead in Indiana to be ❑ 9 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)
r 34 - 23 -a - 3vo - vac. /18 -0a "
City,State ZIP Code County Primary property owner contact name E-mail)