Homestead_Cornwell H. PREPARER
Preparer of the Sales Disclosure Form Title
Chris Sullivan Closer
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd Ste 201,Evansville,IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Lois M.Smith
Address(number and street) Address(number and street)
303 Swallowfield Dr
City,state,and ZIP Code City,state,and ZIP Code
Princeton,IN 47670
Country Country
U 5 A
nde penalties of perjury,I hereby certify 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 6-1.1-5.6.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 6 felony.
7ature of Se r 4 / Signature of Seller
�Name o�r{/0��-/ r Uate si. /d(mm/d� Printed Name of Seller Date signed(mm/dd/yyyy)
Lois M.Smith 02/16/'1 02/16/21
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
r,
YES NO CONDITION YES NO CONDITION t
1.Will this property be the buyer's primary 0 3.Homestead z m 1.11
residence? 0 Zr 4.Solar Energy Heating or Cooling System 8 cr H
/2.Does the buyer have a homestead to be vacated 0 e 5.Wind Power Device z 0o
for this residence?If yes, provide address: 0 JZ 6.Hydroelectric Power Device y Li
C. d
Address(number and street) 0 p' 7.Geothermal Energy Heating or Cooling Del
O
City,state,and ZIP Code County o
26 12-06-200-003.404-028 co
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