Homestead_Fraker ' INDIANA SALES DISCLOSURE FORM SDF ID: 2018 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)
Effie Dilbeck
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
8016 Victoria Dr
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648
Telephone Number E-mail
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".
SL1�n• of iter Signature of Seller
le i 'eck 8/31/2018 8/31/2018
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ��`1 N tgg D'e)e(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY AL ITEIIt�SJHA AFL
Clarissa N. Fraker ) ,.rf ., r),,,
Boyw 1-Nun,, ,.P ors on conveyance document Buyer 2-Name as appears on conveyahceldocu�edf
904 Mohawk Dr
Address(Number and Street) Address(Number and Street) _/)f _ '
Fort Branch, IN 47648 �,Jp'tf! 14t
YES NO CONDITION
0 0 1. Will this property be the buyer's primary 0 0 3. Homestead
residence? Provide complete address of primary ❑ 0 4. Solar Energy Heating/Cooling System
residence, including county:
0 0 5. Wind Power Device
8016 Tess a Dr. 0 06. Hydroelectric Power Device
Address(Number and Street)
'Fort Branch, IN 47648 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,Stay ZIP Code County 0 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.
•. aval able in all counties.
Address(Number and Street)
- -City,State ZIP Code County - ' " •' tact name E-mail