Homestead_Smith (45) e
H. PREPARER
Preparer of the Sales Disclosure Form Title
CHRISTINA LENFERS CLOSING AGENT
Company E-mail address
Address(number and street,city,state,country,and ZIP Code)
501 Main Street,Ste 101,Evansville,IN,USA 47708
I. SELLERS)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
HOUSEHOLD THOUGHTS L.L.0
Addr6ss(�mb and street) �� !-�C/1}� , rl Address(number and street)
City,s te,and ZIP ode ' V CiL City,state,and ZIP Code
tY ,r-r 1 1 /vt1
Coun�s �/ Country
E-mail address Tglr< E-mail address Telephone number
Under 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 6-1.1-5.5.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 5 felony.
i ature of Seller - � � Signature of Seller
Printed Name of Seller to signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) '
BRIAN S.ELLIS,MANAGER 02/26/2021
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
CARRIE R.SMITH
-Addr� s 7 ber an{1 s reet)10 Q Address(number and street)
City, r end ZIP Co dG ��(07 O City,state,and ZIP Code
C J
Coun Country
E-mail aU dress
( )
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
n YES CONDITION - YES/NO CONDITION L�
c RY 1.Will this property be the buyer's primary U 0 3.Homestead cn
ch LL�� residence? p (g�4.Solar Energy Heating or Cooling System z - v ti
in O w H
2.Does the buyer have a homestead to be vacated 0 �5.Wind Power Device
cO for this residence?If yes,provide address: O L'� Hydroelectric Power Device No r
I Address( r and str et) I"
o J DO / 0 7.Geothermal Energy Heating or Cooling Dover C
C , Iv lid t-
26-11-01-100-000.407-027 �City,stat , rZIP Code ��7 nCounty onn J/1 ��n-� 1 (lv l J cy
r
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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