Homestead_Huelsman 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-mail
E. SELLER(S)/GRANTOR(S)
Jerome T.Woehler Patricia S. Woehler
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
503 W. Elm St. 503 W. Elm St.
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 Haubstadt, IN 47639
City, State,and ZIP Code City, State,and ZIP Code
7
belief, is true,correct
and complete as required by law,'and is prepared in accordance wit�(IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
_ 476-1:/,("/, c S'((.�[s2'�/ _
ignature of Seller Signature of Seller
Jerome T.Woehler (p -,: 3- e) Patricia S.Woehler CE) -;:2,3 --c,2
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 DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
A rew C. Huelsman
rs on conveyance document Buyer 2-Name as appears on conveyance document
311 E Ulen St. T f,
Address(Number and Street) Address(Number and Street) :0;,/I j
Fort Branch, IN 47648 ,
City State,and ZIP Coder)(
City, State,and ZIP Code ,J U N 2 5 2020
E-mail Telephone Number mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL 0 LY.
YE NO CONDITION NO CONDITI �//•' i ITOR
C BSON COUNTY❑ 1. Will this property be the buyer's primary El 3 Homestead
residence? Provide complete address of primary 0 0 4. Solar Energy Heating/Cooling System
residence, including county:
0 0 5. Wind Power Device
503 W Elm St. 0 0 6. Hydroelectric Power Device
Address(Number and Street)
IHaubstadt, IN 47639 J Gibson; ❑ 0 7. Geothermal Energy Heating/Cooling Device
ity,State lP Code County ❑ 0 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
address of residence being vacated, including county: • for more information.
Not available in all counties.)
Address(Number and Street)
26-1'8 36r-4y Lr ooQ sa s- — 009
City,State ZIP Code County Primary property owner contact name E- it
License/ID/Other Number