Homestead_Leek 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)
Steven R.Chamblee
Seller 1-Name as appears on conveyance document Seller 2-Name as app r o 'eyan oc jI1):
1730 Lady Bowers Trail —(
Address(Number and Street) Address(Number and Street)
Lakeland,FL 33809 AUG 17 2017
City,State,and ZIP Code City,State,and ZIP Code
j. e•
,. riAn171��; 1
Telephone Number E-mail Telephone Number CIBS(1N CO 2, r ! ' D%T I,r-mail
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 l > olt,Nt�t7.
Clayton T. Leek WV 2 - am I s e
Buyer 1-Name as appears on conveyance document u er 2-Nam s appears on nv an document��//�l ��-,, ��II
2846 W 1125 S Z4-9-t) 1 (tvcoui'✓ A-✓-g-- K1 o 1-C-I--'
Address(Number and Street) Address(Number and S treet)
Haubstadt, IN 47639 01/Pr1f v/j t t(_ ft/'-1-' r7/ C
• THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
7 YES /�0 CONDITION
❑ 1. Will this property be the buyers primary �/ ❑ 3. Homestead
residence? Provide complete address of primary ❑ "4. Solar Energy Heating/Cooling System
residence, including county:
❑ l-"5. Wind Power Device
2846 W 1125 S
Address(Number and Street) ❑ Imo' 6. Hydroelectric Power Device
Haubstadt, IN 47 39 1 Gibson ❑ g/ 7. Geothermal Energy Heating/Cooling Device
City,State ZIP e County ❑ EJ./8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ ❑."4. 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)
a (9 - 0- 1b - aOb - nt? ..I( D - Ian '{
City,State ZIP Code County Primary property owner contact name E-mail