Homestead_Wallis INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page 2
D. PREPARER
Rocksan Underhill 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 rocksan @swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)I GRANTOR(S)
Gregory Glenn Gardner Emily Anne Gardner
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1010 W Gibson St 1010 W Gibson St
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".
Yy�/°/ n � l
Signa re of Seller 'A� l�dg ature .f Seller ..� ^
Gregory Glenn Gardner ) - 1() - k�. Emily Anne Gardner ) )l-1) -* I�
Printed-Name'of-Setter S,gri Date(MM/DD/YYW)— PnnteidName of Seller Sign Date(111MM/Db/Y'YYY)—-
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
CBuyrIWallis Ashlee
2-NaWallis
e, ED
Buyer 7 -Name as appears on conveyance document Buyer 2-Name as appears on conv ce t
108 S Jeremy Lane 108 S Jeremy Lane 2 Address(Number and Street) Address(Number and Street) JAN 2 0 2017
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
ESNO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary Chi) ❑ 3. Homestead
residence? Provide complete address of primary ❑ 4 Solar Energy Heating/Cooling System
residence, including county: 1J
- ❑ 5. Wind Power Device
1010 W Gibson St.
Address(Number and Street) ❑ i 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ /` Y 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ ics€8. Is this property a residential rental property?
k ❑ 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.
IDS S. 3er�� Not available in all counties.)
� L� �
Address(Number and Str t .) L7&3g J(0 - 1E-2L - 401 - /r3 an
4�ysladE lhrtt4 ry y
City State ZIP Code County Primary property owner contact name E-mail