Homestead_Blankenberger (4) INDIANA SALES DISCLOSURE FORM SDF ID: 2019 Page 2
D. PREPARER
Kristina Watson 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 (
E. SELLER(S)I GRANTOR(S)
SPM Development, Inc., an Indiana corporation doing business as
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 by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
I� a
SrAV-It • Signature of Seller
Pri'ted Name•f Seller Sign Date(MM/D YYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS((( � -IDENTIFY ALL ITEMS THATf APPLY
4 Jeremy D. Blankenberger (� �„ ►. JI6
our , - . - as appears on conveyance document Buyer 2-Nam s apphra,4 on conveyance document
203 S West St 2-0 3 5 u.A sf SG .
Address(Number and Street) Address(Number and Street)
Ft. Branch, IN 47648 ilatrJ� 1.Ipu�p � L/ ' i.,,
E-mail Telephone Number MAY q1 O� 'n E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY A L F THOSE THAT APPLY.
��^YE���S NO CONDITION _yes NO— CONDITION _DITN
❑ 1. Will this property be the buyers primary �� 0 3. Homestead
vi /// residence? Provide complete address of primary ❑ 4. Solar EneE BBaillr@ratINTig Wei-TOR
residence, including county:
1453 W Chukar Hollow 0 5. Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
Haubstadt, IN 47639 t Gibson ❑ 7. Geothermal Energy Heating/Cooling Device
City,St�at/gZIPCode County 0 8. Is this property a residential rental property?
❑ 9Q 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.
Not available in all counties.)
Address(Number and Street)
014 -l8-3lo e3oo - oo4.793 -o cty
City,Stale ZIP Code County Primary property owner contact name E-mail