HomeMy WebLinkAboutHomestead_Rogers INDIANA SALES DISCLOSURE FORM SDF ID: 2017 -. Page 2
D. PREPARER
Teresa S. Holifield 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 teresa @swinland.com
City, State,and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Walter C. Rietman, by Diane L. Lamey,Attorney-in-Fact
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
106 N Hull St
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 complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Lr ' r pr Z
Signature of Seller r/ Signature of Seller
Walter C. Rietman, by Diane L. Lamey, 10/4/2017 10/4/2017
Attorney-in-Fact
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
Chrysanne Rogers
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyanc ment
9928SJoyLn It Address S J(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFYAt,Yr SE THAT APPLY.
YES NO CONDITION YES NO CONDITION y`�th1i.
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead q/rO
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling�y; m
residence, including county:
❑ 0 5. Wind Power Device
106 N Hull St.
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
pity, State ZIP Code County ❑ 0 8. Is this property a residential rental property?
�,YIL'/ ❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
ad ress of residence being vacated, including county: below. Please see instructions for more information.
�� SV( L-'1 • Not available in all counties.)
Address(Number and Street)
40404tH �iki Li-763g b. ,-, Z 4,-iS - 3 b +O a ono 335 009
City, State ZIP Code County Primary property owner contact name E-mail