Homestead_Conklin 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)
Karen R. Harbison
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12752 S Sunset Dr
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 as required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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Sig ature of Seller Signature of Seller
Karen R. Harbison 5/26/2017 5/26/2017
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ___ Sign Date/M�M,/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITE� TEE- )
Roger L. Conklin Rebecca G. Conklin ��``
.Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyanc'lt Qppuwept 2017
3003 W 10505 3003 W 1050S 111V
• %Address(Number and Street) ' Address(Number and Street)
Haubstadt, IN 47639 - Haubstadt, IN 47639
""
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
70 ❑ 1. Will this property be the buyer's primary 50 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 4. Solar Energy Heating/Cooling System
• residence,including county: I
❑ Vi 5. Wind Power Device
12752 S Sunset
ra Dr. I
nd Street)
Address(Number and ❑ 6. Hydroelectric Power Device
Haubstadt, IN 47639 j Gibson' ❑ 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ '® 8. Is this property a residential rental property?
t) ❑ 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.
))O k 3 (A// 05-0S Not available in all counties.)
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A ress(Number and Street q� i s n6-��
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City,State ZIP Code County Primary property owner contact name E-mail
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