Homestead_Smith (49) •
H. PREPARER
Preparer of the Sales Disclosure Form Title
Jerry D. Stilwell Atttorney at Law
Company
Address(number and street,city,state,country,and ZIP Code)
302 N. Prince Street, Princeton, IN 47670
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on co eaoelpcu
Robert J. Smith, III 11 11
Address(number and street) Address(number and street) 4'
3010 S. Old Highway 41
City,state,and ZIP Code City,state,and ZIP Code APK 0 8 2022
Princeton, IN 47670
Country Country A hi-C ttLGi a. . .rwJ
USA GIRSON C UNTY AUDITOR
E-mail address
( )
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.
)Tnatur e Signature of Seller
r
Printed Name Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
ROBERT J. SMITH, III 03/31/2022
J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document
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 N NDIITION
0 O 1.Will this property be the buyer's primary 3_Homesiead=.-
residence? Q WI 4. Solar Energy Heating or Cooling System
0 ® 2. Does the buyer have a homestead to be vacated 0 WI 5.Wind Power Device
for this residence? If yes, provide address: p WI 6. Hydroelectric Power Device
Address(number and street) 0 II 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
A - /l -.? S' - .I.oa_ oo.r,. 67'`! 9-aA7
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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