Homestead_Dilbeck (3) 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)
Jason J.Weyer Amy M.Weyer
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
752 W Brayden Dr 752 W Brayden Dr
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 comptete as r i ed b law,and is prepared in accordance with IC 6-1.1 5.5, "Real Property Sales Disclosure Act".
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/ gnatu of Seller r% _ Signatu a of Seller �/' r
son J.Weyer ✓ / / 7 Amy M. Weyer CJ .5-;) -7)
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 •
Jacob J. Dilbeck Lindsey E. Dilbeck
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
'14#9>1/47:
424 S West St,Apt D 424 S West St,Apt D
Address(Number and Street) Address(Number and Street) ,SJA ..
Haubstadt, IN 47639 Haubstadt, IN 47639 04 .�
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 .
\Q� ❑ 1. Will this property be the buyers primary ❑ 3. Homestead
II residence? Provide complete address of primary 0 p 4. Solar Energy Heating/Cooling System
residence, including county:
752 W Brayden Dr.
❑ 0 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Haubstadt, IN 47639 1 Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County CI El 8. Is this property a residential rental property?
❑ 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
addr ss of residence being va t d, including county: below. Please see instructions for more information.
( 03V-1- ("A�I j ,residence Not available in all counties.)
l ss(Numb lr and Streeet')�'I L
a o f� (/•/ 9/7as ✓r �