Homestead_Polston ,
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)
Dixie Lee Roettger, Life Estate Larry Wira,Jr.
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6737 S 950E 6737 S 950 E
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660 Oakland City, IN 47660
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
and complete late as required by law and is prepared in accordance with IC 6-1.1- "Real Prop Sales D'sclosure Act".
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14/ —OR 0717 L- Wir., Jr. I - 07 17
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 -
, PLY.
YES NO CONDITION YES NO CONDITION -�(?--
❑ 1. Will this property be the buyer's primary ❑ 3. Homestead `?
residence? Provide complete address of primary 4. Solar Energy Heating/Cooling System
residence, including county:
6737 S 950 E ❑ 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Oakland City, IN 47660 i Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 8. Is this property a residential rental property?
❑ 90 2. Does the buyer have a homestead in Indiana to be ❑ 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) 999—00/
City,State ZIP Code Count), Primary property owner contact name E-mail