Homestead_Rigsby INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page 2
D. PREPARER
Teresa S. Holifield 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 teresa @swinland.com
City,State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
K Development Group, Inc., an Indiana corporation
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2997WSR68
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 �le as require rid is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Si ature of Seller Signature of Seller
Rita Kiesel,Asst Manager 6/2/2017 6/2/2017
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller n/iaD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL IT A1I L
enneth 8. Rigsby Melissa E. Rigsby V c�n7 nt ZD(�
r-I appears on conveyance document Buyer 2-Name as appears on conveys
105 S Walters St 105 S Walters St
Address(Number and Street) Address(Number and Street)
-
Fort Branch, IN 47648 Fort Branch, IN 47648
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 r10 CONDITION
/�,3Q\/ ❑ 1. Will this property be the buyer's primary 3. Homestea
residence? Provide complete address of primary ❑ 4. b ar nergy Heating/Cooling System
residence, including county:
9949 S Water Tower Dr
El 5. Wind Power Device
Address(Number and Street) El 6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
City, State IP Code County ❑ e 8. Is this property a residential rental property?
❑ J 2. Does the buyer have a homestead in Indiana to be ❑ g, 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.
Not available in all counties.)
Address(Number and Street) 1/4, _ / p rid - 2.00 _ 0 04 . ?f Y-o0Lk
City,State ZIP Code County Primary property owner contact name E-mail