Homestead_Titzer INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page 2
D. PREPARER
Teresa S. Holifield 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 teresa @swinland.com
City,State, and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Richard Smith Monica Smith
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12860 S Sunset Dr 12860 S Sunset Dr
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 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
rid corn lete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sal s Disclosure Act".
Signature of Seller Signature of Seller
Richard Smith 10/13/2017 Monica Smith _ 10/13/2017
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
Tabitha M.Titzer L.41 9
�tlHJ^`1
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on a ee.bogrnien
9233 S 100 E
Address(Number and Street) Address(Number and Street) UL I 1 9 Lu 17
Ft. Branch, IN 47648
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
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
502 N Railroad St.
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Fort Branch, IN 47648 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ ji2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
1 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) //
Off,- IS-13 84-Da ca
3 ca
City,State ZIP Code County Amory property owner contact name E-mail