Homestead_Shaw H. PREPARER
Preparer of the Sales Disclosure Foes 1 Title
Gwyn Shaw i Escrow Officer
Company
Address(number end street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A.Evansville,IN 47715
I. SELLER(S)/GRANTOR(S) -� TTE_D
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on convyeiit r[snt
Elisha A.Smith - - L
Address(number and street) t.
f ot,I `- t.C-, rr�." r ' (Ii'C- Address(number and street)
MAY 3.1 2022
City,state,and ZIP Code _
` ,o w b�.r-s y r I"7`-- L. City,state,and ZIP Code f�f
Country- - V\ '.'t (W J Country t!� Cr 0 T Y AUDITOR
OR
United States of America United States of America GIBSON
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 falsifis any information required to be provided,commits a Level 5 felony.
Signature of Seller `� .3 `" Signature of Seller
Printed Named Seller Dale signed-(mmi ) Printed Name of Seller 1 Date signed(mm/ddtyyyy)
Elisha A.Smith ZiQ
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 appears on conveyance document
_ Kaylee E.Shaw Noah J.Evans
Address(number and street) Address(number and street)
113 S_Damosa Drive 113 S.Damosa Drive
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt,IN 47639 Haubstadt,IN 47639
Country Country
United States of America United States of America
- Email address
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
kr 0 3. Homestead
32( ❑ 1.Will this property be the buyer's primary residence? 0 Q 4. Solar Energy Heating or Cooling System
DUI
2.Does the buyer have a homestead to be vacated for 0 05.Wind Power Device
this residence? If yes, provide address: 0 RI 6.Hydroelectric Power Device
Ad a s,(number an street) 0 7. Geothermal Energy Heating or Cooling Device
( VD Yh2• A[1Q -
City,state,and TIP Code County
Al �{27ae) a6-1i - 36-Lio3 -000. o�c-t -octet
Under t<�L/! -
e .�,_
Uner 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 property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's
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