Homestead_Blankenberger (3) 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)
Loren L.Rogers Chrysanne M. Rogers
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9928 S Joy Ln 9928 S Joy Ln
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 co plete as requir d by law, and is prepared in accordance with IC 6,;.1 5�Property !es Disclosure Act".
� 1 Seller n Y�
Sign lure of Seller nature o eller
Loren L. Rogers 8/24/2017 Chrysanne M. Rogers 8/24/2017
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
R BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS FIIT,LV D
Lance M. Blankenberger Ashlee D. Blankenberger 19
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
9293 S 225 W 9293 S 225 W AUG 2 9 2017 .
Address(Number and Street) Address(Number and Street)
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
❑ 1. Will this property be the buyer's primary \1 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 5. Wind Power Device
9928 S Joy Lane ❑ 6. Hydroelectric Power Device
Address(Number and Street)
pfit5adt, IN 47639 i Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
r State ZIP Code county ❑ tD 8. Is this property a residential rental property?
2. Does the buyer have a homestead in Indiana to be ❑ Q 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.
(J 1 C 3 2-� r . 1 Not available in all counties.)
d_dlressss(Nu 1 er and reeq t�J
and reel) Ire L-4,1te 'E 1 G-1 R-35 - l co -oo . I so?t1914
City,State ZIP Code �)'1^�Cou�nty Primary property owner contact name E-mail