Homestead_Brackett INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Sheni S Hudson Closing Manager
Preparer of the Sales Disclosure Form Tide
501 Main Street.Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000 closing.denR&ieffbosse.com
City,Stat4 and ZIP Code Telephone Number E-mail
le.iseLlini(s)JGRANTOR(S)142;::
Justin A.Dix Tasha A Dix
Seller 1-Name as appears an conveyance document Seller 2-Name as appears on conveyance document
e(7?3 kr/ ,-r• Cs:173 W Lt(tS
Address(Number and Street) Address(Number and Street)
I:fA24-'-"47/1 1/1/ rzas- b,,...ans\ALke_ fti 4-11-tikt
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complet• •s re.•u' 1. I. and is prepared in accordance with IC 6-1.1-5.5,"Real Prope • : Disclosure Act".
":”<eraf Sel er Signature of Seller -411r
ustin A Dix 7-/7-// Tasha A.Dix —I-1
Printed Name of Seller Sign Date(MVDD/YM) Printed Name a(Seller te 0114/01)/YYM
F;TBUYER S GRANTEE S APPLICATIONlF0FCPROFIERTYJAXVEDUCTIONSXIDENTIFY•AL.B1 TiA
- Donald R.Brackett
Buyer 1-Name as appearsarconveyance document Buyer 2-Name as appears on conveyance document
424 S.West Street Apt E JUL 1 9 2017
Address(Number and Street) Adds-Ems(Number and Street)
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
Er D 1.Will this property be the buyer's primary R11. 0 3.Homesteac5
residence? Provide complete address of prima _ u j .Solar Energy Heating/Cooling System
residence,including county:
0 5.Wind Power Device
Address(Number and Street) 171 6.Hydroelectric Power Device
0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 Er 8.Is this property a residential rental property?
0 21# 2.Does the buyer have a homestead in Indiana to be th
vacated for this residence? If yes,provide Li 171 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
a-4 - 79 _f 9 - 070Li - 00 / 3/01 -o .lz
City,State ZIP Code County
Primary property owner contact name E-mail