Homestead_Jost (6) 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)
Gregory M.Lewis Jackie T. Lewis
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
409 S West St 409 S West St
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 c plete r�P[ i adl by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
`Signal of eller Signature�fSeller�� -
\Gregory M. Lewis 4/14/2017 ackie T. Lewis 4/14/2017
Printed Name of Seller Sign Date(MM/DD/YYVY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Donald J.Jost
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance d e t
501 E Plum St,Apt A
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 9pp -
✓!. -PLY.
YES NO CONDITION YES NO CONDITION 4/,
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead G�r0 •
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence,including county:
409 S West St. ❑ 0 5. Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
•Haubstadl, IN 47639 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
ddress of residence being vacated, including county: below. Please see instructions for more information.
[�1 (C- R�1Lj4u I L Not available in all counties.)
JAddress(Number and Street)
IA-AA)PAT/ 0 T frit-0(03 I (911.050\.. cg-d0,1-o/-o?cV- ab. 0136-cb9
City,State ZIP Code County Primary property owner contact name E-mail