Homestead_REibel 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 (
City, State, and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Jeremy R. Seib Emily R. Seib
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2421 W 1025 S 2421 W 1025 S
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
City, State,and ZIP Code
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".
Signature oler Signature of oeller
Jeremy R. Seib 6/28/2019 Emily R. Seib 6/28/2019
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIO - LL ITEMS THAT APPLY
Eugene ReibelBuyer 1-Name as appears on conveyance document iB111E13
2-Name as appears on conveyance document
18052 Leavenworth St ,11` 0 11,1019
Address(Number and Street) Ada(Number and Street)
Elkhorn, NE 68022 f
onE um er E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDU IONS FOR THIS THIS PROPERTY. IDENTIFY ALL OF HAT APPLY.
YES NO CONDITION YES,, NO CONDITION
Ir
`❑ 1. Will this property be the buyers primary CNC 0 3. Homestead
residence? Provide complete address of primary —*—Sofa ea ing Cooling System
residence, including county:
2421 W 1025 S 0 ❑ 5. Wind Power Device
Address(Number and Street) ❑ ❑ 6. Hydroelectric Power Device
Fort Branch, IN 47648 I Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City,Sta a ZIP Code County 0 ❑ 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ ❑ 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 ailabte-ii nit Low JCL .
Address(Number and Street) / O v 20 Aloo00z, 2,93aa4
City, St. - -Code Counik-N\ Prima property owner contact name E- it
t
License/ID/Other Number
I
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