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Homestead_Clark
H. PREPARER Preparer of the Sates Disclosure Fonm Title Laura Neal Title Company Company Address(number and street,city,state,country.and ZIP Code) 7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715r. " . -. I. SELLERS)/GRANTOR(S) Seller 1-Name as it appears on conveyance document ; Seller 2-Name as appears on conveyance document Kevin P.Johnson Kimberly L.Johnson Address(number and street) Address(number and street) 507 Oak Grove Church Rd. 507 Oak Grove Church Rd. City,state,and ZIP Cede City,state,and ZIP Code Mount Airy,NC 27030-9029 Mount Airy,NC 27030-9029 Country Country US US ( ) / 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 to accordance with IC 6-1.1-5.5.A parson who knowingly and Intentionally falsifies the value of transferred real • o•,• or . Its or falsifies any Information required to be provided,commits a Level 5 felony, .• . Si-,at °er Sig ature o Sefier ii Lpi is a { -•nte: :F"': . :Mier` Date signed(mmlddtyyyy) i Printed Name of Iter (�- Date signed(mmfddtyyyy) .02/g•y2g22 1/�(/zt-- Kimberly L.Johnson Any= 83f0772622 1/3G/z 2.- Kevin P.Johnson , 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 ft appears on coa�yunt lcum rF 0 Richard•Eugene Clark Stephanie Clark 1f ■L ` J 1 'J • Address(number and street) , Address(number and street) rr��qq9 68 W.800 S. 68 W.800 S. FEB o 9 2ULL • City,state,and ZIP Code City,state,and ZIP Code Fort Branch,IN 47648 Fort Branch,IN 47648 y� Country Country R//2 ,' z4.0 ✓ US US GIBSON COUNTY AUDITOR -' 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: YES NO CONDITION ' YES NO CONDITION 1.Will this property be the buyer's primary (V C) 3.Homestead ® Ca residence? 0 t9 4.Solar Energy Heating or Cooling System J2.Does the buyer have a homestead to be vacated 0 al 5.Wind Power Device 0 or this residence?If yes.provide address: 0 03 6-Hydroelectric Power Device Address(number and street) 0 lip 7.Geothermal Energy Heating or Cooling Device City,state,and ZIP Code County qwi f-1 O-0 6 ©f--' 3 o3 -o o o.3-2-g - o 2 2- - Under penalties of perjury.I hereby certify that 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 prope or falsifies any Information required to be provided,commits a Level 5 felony.(Note:Both spouse's Information,SS censellOIOther Number Is necessary if a Homestead Deduction Is beln