Homestead_Cox (4) INDIANA SALES DISCLOSURE FORM SDF ID: 2019 Page 2
D. PREPARER
Amy Pollard 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 (
mail
E. SELLER(S)/GRANTOR(S)
SPM Development Inc., an Indiana corporation dba Reinbrecht •
Homes
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
304 E SR 68
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
City, State,and ZIP Code City, State,and ZIP Code
%.,,
E-mail 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 b law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
C- n lure o lit r1 • Signature of Seller
:rill IS; FT;i4ifft r1\ sn/2o19 5/7/2019
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F.F. BU RANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL I nTJ EJL/
Kevin Cox Rhea Cox
s appears on conveyance document Buyer 2-Name as appears on conveyance document
426 Bradley Dr 426 Bradley Dr MAY 9 2019
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 Haubstadt, IN 47639
City,State,and ZIP Code
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO ISPROPER-F . TIFY ALL OF THOSE THAT APPLY.
YE NO CONDITION S NO CONDITION
El 1:_Willahis property;be the buyer�pr mary,i ` ,❑ . 3-Home ead
residence? Provide complete address of primary jjjj'"'
eating/Cooling System
residence, including county:
❑ 5. Wind Power Device
10005 S Quail Xing
Address(Number and Street) ❑ 6. Hydroelectric Power Device
•Haubstadt, IN 47639 I Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
ity,State ZIP Code County 0 _ 8. Is this property a residential rental property?
{ " ''"-'' 0 9. Would you like to receive tax statements for this
1. ` ❑t- 2?iDoes4Bebuyer_haye athomestead irtjlndiana to.be�
vacated for this residence? If yes, provid ce omplete, property via-email? (Provide contact information
address of reside. being vacated, including county: v✓. Please see s for more information.
,I •r Not available in all counties.)
f 'ress(Number ntl Stre t) r r� t _ ^3 O -0Or� •—( 1 , 4-0 z.
i. State ZI Code County P�nnmaaarryy property owner contact name '/1\ T U1 E-mail