HomeMy WebLinkAboutHomestead_Ellermann INDIANA SALES DISCLOSURE FORM SDF ID: 2017 _ Page 2
D. PREPARER I
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) .
Seller 1-Name as appears on conveyance document - - - Seller 2-Name as appears on conveyance document
Address(Number anc Street) - Address(Number and Street)
•
City,State,and ZIP Code - - . . - City, State,and ZIP Code
Telephone Number E-mail Telephone Number E-mail
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".
Signature of Seller - Signature of Seller
- - 3/24/2017 3/24/2017
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 J. Ellermann Tara L. Ellermann
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on'conveyance document
—$.134).4.21.1•stafe-adr - I LDt5 N R-i'I(c eaj= tbf. 400-4-N-stud-07 / 4 If( f ' r
Address(Number and Street) �(rj /�- - - - Address(Number and Street) C
Vincennes, IN 47591 �� Vincennes, IN 47591 y
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION MAR 2'9 2017
❑ 1. Will this property be thebuyer's primary ❑ 3. Homestead,
residence? Provide complete address of primary ❑ 8 q, Solar Energy Healing `bolin
residence, including county: ' TT++fflr
1346 S Old State Road 65 ❑ 8 5. Wind Power�B6ON COUNTY AUDITOR
Address(Number and Street) - ❑ 8 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson' El 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 8 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 8 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 bein bated; including county: below Please see instructions for more information.
Not available in all counties.)
ress(Number and Street)
A )
) nN e v-\viz s i rr q--13-€1 L. U o)e 010-1 1- 17-you.-opt 789-09;
City. State ZIP Code County Primary property owner contact name E-mail