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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)
Thomas E Chamberlain Family Trust dtd 08/22/2016
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
24 Laurelcrest Ln
Address(Number and Street) Address(Number and Street)
Travelers Rest, SC 29690 ,
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 repared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
2/17/2017 2/17/2017
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 ALL ITEMS THAT APPLY
Andrew B. Dunkel
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance do m r1S tpb
6173 175 Addree ss(Nuu mber and Street) Address(Number and Street)
Ft. Branch, IN 47648
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY AL r `.0� :T • •PLY.
YES NO CONDITION YES NO CONDITION •V,. wit ,
') ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead q(/py
residence? Provide complete address of primary O 4. Solar Energy Heating/Cooling SystemTOR
residence, including county:
104 S Race St. ❑ El 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
• aubstadt, IN 47639 Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ E 8. Is this property a residential rental property?
❑ p 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.
Not available in all counties.)
Address(Number and Street)
££ - / 9- 3/- 303- coo. o57-1- o09
City,State ZIP Code County Primary property owner contact name E-mail