Homestead_Clayton 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)I GRANTOR(S)
Lloyd Heldt
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
8406 E 900 S
Address(Number and Street) Address(Number and Street)
Elberfeld, IN 47613
Under pen- ies of per' I her-by certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
a d c•m• et- as .11C• by,. , a..;rs •re•-;-d in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
f u/SAt. t/S_ ti /
gnature of:eller Signature of Seller
L oyd Heldt
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
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Gilbert T. Clayton _
. Buyer 1 -Name as appears on conveyance document Buyer 2-Name as appears on conveyance do t
5336 Sandpiper Ln b
Address(Number and Street) Address(Number and Street) OCT
Evansville, IN 47715 `�� 7".
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THATAPPLY.
YES NO CONDITION YES NO CONDITION cO'To?
El ❑ 1. Will this property be the buyer's primary El ❑ 3. Homestead
residence? Provide complete address of primary ❑ El 4. Solar Energy Heating/Cooling System
residence, including county:
❑ El 5. Wind Power Device
8406 E 900 S
Address(Number and Street) ❑ El 6. Hydroelectric Power Device
Elberfeld, IN 47613 I Gibson ❑ El 7. Geothermal Energy Heating/Cooling Device
City, S 6 ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 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
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
go- °V -if-a100 - or6516-col
City,State ZIP Code County Primary property owner contact name E-mail