Homestead_Clem (2) 1
INDIANA SALES DISCLOSURE FORM SDF ID: 2020 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 (
E. SELLER(S)/GRANTOR(S)
SPM Development dba Reinbrecht Homes
Seller 1-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 perj , I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and co = --re.•red by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature of Sell ,Signature of Seller
H C9a A.,. 4/29/2020 4/29/2020
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller � 'o-..•ate(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY AL �TtA THrrrr�����rrrr P
Nancy G. Clem �� ����ll
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on corgr,�Xgnc®d�ct
4999 E.200 N �IVV�IHH I
Address(Number and Street) Address(Number and Street) ��++
Princeton, IN 47670 , `pU1Q
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO . ALL OF THOSE THAT APPLY.
Y NO CONDITION NO CONDITION
El 1. Will this property be the buyer's primary 0 3. Homestead
�/ residence? Provide complete address of primary lI 4. 5olarlrser9Y eating/Cooling/Cooling System
residence, including county:
0 E1 5. Wind Power Device
544 S Cathy Dr.Address(Number and Street) 0 p 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson, ❑ El 7. Geothermal Energy Heating/Cooling Device
Ci ,State ZIP Code County El 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
zta£ 7
ddr ss of residence bei g vacated, including county: below. Please see instructions for more information.
O(\ Not available in all counties.)
dress(Number and Street) v �(o-1 I - 1
S' a Od_v('r /, -7 3 3_D3--7
` •� ���� ��I�' Primary property owner contact name `f' E-mail
City,State ZIP Code County
License/ID/Other Number