Homestead_Mosier INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
[D?;P,REPARER1 t L. -- - 4 , 4 {-Tr-- —.- .` -.. : . , . r . . - - . :•
Pam Hancock title administrator/closer
Preparer of the Sales Disclosure Form - Title
221 NW Fifth St Lockvear Title. LLC
Address(Number and_Street) Company
Evansville, IN 47708 . 812-421-8405 pamela(t lockveartitle.com
City,State,and ZIP Code Telephone Number E-mail•£.SELLER(S)'(,GRANITQR(S)1 •.C7:7•7:71:77:- '„° .• - .. 77;777.77.7-7-217.1”' ' - .•
Revocable Trust Agreement of Patty S. Neufelder dated January 26, 1999, as amended
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
/00 Chiltea [ti 'Dr
Address(Number and Street) Address(Number and Street)
Pend l e -I'on
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 re wired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
CfiA . p
Signature of Seller Signature of Seller
Patty S. Neufelder, as Trustee 11-16 -17
.Printed Name of Seller Sian Date(MMIDD/YYY'Y Printed Name ofSeller Sian Date(MM/DD/YYM
f.:i" ,•Y:ER(S)'/,GRAN_TEE(S)EAPT E'ATIONIF,GRIP:RORERTtYLTAX D.ED.U.RIONSLIDENITIVA111,91TE 1SyTHAVAge. 1': '` - -
Brent Mosier and Vicki Mosier,husband and wife
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
.
10045 S. Partridge Avenue y'
Address(Number and Street) r Address(Number and Street) /1/
Haubstadt, IN 47639 I �
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPL1rki.J.�i
YES NO CONDITION YES NO CONDITION '1/O_ -
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead /r0
residence? Provide complete address of primary R
residence,including county: ❑ 4.Solar Energy Heating/Cooling System
'10045 S. Partridge Avenue ❑ 5.Wind Power Device
Address(Number and Street) ❑ in 6.Hydroelectric Power Device
Haubstadt, IN 47639' Gibson ❑ 12 7.Geothermal Energy Heating/Cooling Device
City,State ZIP/.ode County
IN
❑ Q/ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 12 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) Iii ,
at-/I-36 - 30G- noa. /•5-O-602 7�
City State ZIP Code County
Primary property owner contact name E-mail
•
