Homestead_Carter (10) INDIANA SALES DISCLOSURE FORM SDF ID: 2018 Page 2
D. PREPARER
Teresa S. Holifleld 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)
Ryan C.Clevenger
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1005 1/2 Center
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 ,
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and co •plete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
P ILA ,4 - AA./
ignaturie of Seller / Signature of Seller
Ryan C. blevenger 3/30/2018 3/30/2018
Printed Name of Seller Sign Date(MI✓✓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 P1PLY
•CassaundraA. Carter COAUS a. Cfiic+ r 1 R. f 'I LS /CAI d) 14°4' i a
Buyer 1 -Name as appears on conveyance document Buyer 2-Name as appears-fin conveya cocument -{'1 ,�`lL
9901S450E gg01 S-4S I C
Address(Number and Street) 'f ddress(Number and Street)
� � /'� p
Haubstadt, IN 47639 -1 a/19S kJ-AL - -N C O I
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL 0 0 E AT
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/ColitiOWtet018
residence, including county:
❑ 0 5. Wind Power Device
1005 1/2 S Center St
Address(Number and Street) ❑ 0 6. Hydroelectric Power Devi i , • li�^'tli
Fort Branch, IN 47648 I Gibson ❑ 0 7. Geothermal Ener ( ertj•• • I$VJC TOR•
City, Slat 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)
as-18- 4- ao4 -elo.(o1/8-6040
City,State ZIP Code County Primary property owner contact name E-mail