Homestead_Poelhuis INDIANA SALES DISCLOSURE FORM SDF ID: 2018 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)
Joseph A. Massa, Jr. Wynnetta Sue Massa
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2448 E Warrenton Rd 2448 E Warrenton Rd .
Address(Number and Street) Address(Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
a mplete as re ired by law, and is prepar in accordance with ICC6-1.1-55.5, "Real Property Sales Disclosure Act".
C7e1Ci7F z, -t z' i}�r.s lin rl.al.-�
atureof• et-- SigriatuierofSeler"
Jos h A. M sa,Jr. 11/15/2018 Wynnetta Sue Massa 11/15/2018
Tinted Nameot-Seiter i n Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
. BUYER(S)/GRANTEE(S) -APPLICATION FOR P TY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Debra J. Poelhuis, by Annette L. Seybold,Attorney-in-Fact p-� p �� 19
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears o onv a e rdfx;`lmb f"
ralou Drive _
Address(Number and Street) Address(Number and Street) NOV 21 2018
Fleetwood, PA 19522
(
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIO OR THIS PROPERTY. IDENTIFY ALL OF SE THAT APPLY.
YES NO CONDITION ES CONDITION
0 1. Will this property be the buyer'sY
primary O 3. Homes ead
residence? Provide complete address of primary p Solar Energy Heating/Cooling System
residence, including county:
0 5. Wind Power Device
2448 E Warrenton Rd.
Address(Number and Street) ❑ g 6. Hydroelectric Power Device
Haubstadt, IN 47639 I Gibson' El iSe 7. Geothermal Energy Heating/Cooling Device
,�1--- State ZIP Code County Ell� Is this property a residential rental property?
/� �!/)0 2. Does the buyer have a homestead in Indiana to be ❑ 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.
2. C rc I Not available in all counties.)
lbU I a s�
�Alddress(Number,, band-Setteed ^ I 1� o26 — I _1�' Flo - oni . 6 I -0A4
` ` 'ram {{1I,�J lT Primary property ownercontact name E-mail
City, State ZIP Code County