Homestead_Elpers (44) 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)
Ryan S.Hart Brooke S. Hart
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2940 W St Rd 68 2940 W St Rd 68
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 complete required by law,aw, as prepared in accordance with IC 6,1.1-575.3 "Real ro S�t¢s�Disosure Act".•
" Sig nature of Seller /J »`JJ Signature of Seller F\X/ H
Ryan S. Hart 3/13/2017 Brooke S. Hart 3/13/2017
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)IGRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Joshua J. Elpers
appears on conveyance nt 1
10110 Summit Park Place,Apt 202 10110 Summit Park Place,Apt. 202
Address(Number and Street) Address(Number and Street)
Louisville, IN 40241 Louisville, KY 40241 MAR 16 2017
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALGOP THOSE IVI APPLY UUI I UK
YES NO CONDITION Y,E,rS, NO CONDITION
I ❑ 1. Will this property be the buyers primary ❑ 3. Homestead
residence? Provide complete address of primary ❑ 5 4. Solar Energy Heating/Cooling System
residence, including county:
2940 W State Road 68 ❑ 0 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson ❑ a 7. Geothermal Energy Heating/Cooling Device
�`rrCyCiity,State ZIP Code County ❑ 2 8. Is this property a residential rental property?
y ❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
I vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated,.including count below. Please see instructions for more information.
150Y1 ttWnit Not available in all counties.)
L ss(Number and Street)
1,�/sy(rc� ,n7 ?7�s � �� a( — aa -o3-ioo-ow. i0a-gay
City, ZIP Code County Primary property owner contact name E-mail