Homestead_Miller (12) INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page 2
D. PREPARER
Kathy Masterson Escrow Officer
Prepare(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)
Calvin James Davis
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
425 E 200 S
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
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 p epared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Calvin James Davis C>U15doI /
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
Jerico N.Miller Kelsey M.
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on cony ncentp�
3174W50S 3174W50S
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 /
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF U$FATFt T APPLY.
YES NO CONDITION YES NO CONDITION Oft
Clt ❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary
residence, including county: ❑ ❑ 4. Solar Energy Heating/Cooling System
151E200S
❑ El 5. Wind Power Device
Address(Number and Street) ❑ ❑ 6. Hydroelectric Power Device
!Princeton, IN 47670 I Gibson ❑ ❑ 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ ❑ 8. Is this property a residential rental property?
❑ ir 2. Does the buyer have a homestead in Indiana to be ❑ ❑ g. 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)
10 -IQ -19-tia6 3'3aoa-7
City, State ZIP Code County Primary property owner contact name E-mail