Homestead_Smith Jr H. PREPARER
Preparer of the Sales Disclosure Form I Title
l Q-041 , �.eo.. i Settlement Agent
Company
Address(number and street oily state.country.and ZIP Code)
20 NW 1st Street.Suite 100,Evansville,IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Se Ier 2- Name as appears on conveyance document
Ryan S.Hart i Brooke S.Hart
Address(number and street) ? Address(number and street)
406r..6 can a Rr- t(tat) (Jo- "�t lgue 4n6 50.S Rd S"v`•._{%
City.state.and ZIP Code �ISt.Q ( I City state.and Code
� cvt / (14 I.{•,,r}.c��.rf,IN 47639 �
-'r'' ' f..
Country + Country
US US
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
Signature of Seller r atuoe of S lei
►�- C4.
Pnnt�of Seller Onto signed(rnm/ddryyyy) anted Name of Soifer ; Date signed(mmlddlyyyy)
Ryan S.Hart 05/19/2022 Brooke S.Hart 05/19/2022
J. BUYER(S)IGRANTEE(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
Gary Scott Smith,Jr. Robyn
dres Melissa Smith FILED
Address(number and street) Address(number and street)
4066E 950 S Rd 4066E 950 S Rd
City stale and ZIP Code City state,and ZIP Code
Haubstadt,IN 47639 Haubstadt,IN 47639 MAY 2 4 2022
Country Country
US US .../4!a.
--- ___ I Email address -.15fu1 •
E-mail address GIBBON Q@11.
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 1 YES NO CONDITION
Q property y P ry
1.Will thisbe the buyer's primary i le 0 3. Homestead
residence 0 ® 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 l55 5.Wind Power Device
O for this residence? If yes. provide address 0 ® 6.Hydroelectric Power Device
Address(nyFnber and street) 0 ® 7.Geothermal Energy Heating or Cooling Device
City,state ZIP code,and county L l()',(',- ^ !—2 G G—0 OO• Iv 0 — 0 2, -
LicensetlO/Other Number
Page
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