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Homestead_Smithb. H. PREPARER Preparer of the Sales Dis4osure Form ITitle (wai 1� Title Company _-__.... Company _ N Address(number and street.city.state.country,and ZIP Code) 7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715 I. SELLER(S)/GRANTOR(S) _ - -- -- — Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Jared D.Mitchell Megan N.Mitchell Address(number and street) Address(number and street) 4060 E Valley Pass 4060 E Valley Pass City.state.and ZIP Code City,state,and ZIP Code Haubstadt,IN 47639 _ Haubstadt,IN 47639 -------^ Country Country Cou ou US US real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. _ Signal �fSellerSignal r of Seiler Printed of Seller Date signed(mm/dd/yyyy) Printed Name eller Date signed(mmldd/yyyy) Jared D.Mitchell J 05/31/2022 Megan N.Mitchell 05/31/2022 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 Matthew W.Smith Sarah J.Smith Address(number and street) Address(number and street) 1682 E.Autumn Rgd 1682 E.Autumn Rgd City,slate.and ZIP Code — - - City,state,and ZIP Code Haubstadt,IN 47639 Haubstadt,IN 47639 --Country CountryUS •4 US E-mail address Telephone number E-mail address / Telepito ie number 1 mws101784@hotmail.com I (812)457-5504 / ' ( _ _�. Q Pursuant to IC 6-1.1-12-44,the Sates Disclosure Form may be used to amply for certain deductions Identity all of those that apply: � I YES NO CONDITION YES NO CONDITION O fg- O 1.Will this property be the buyer's primary I(X+ D 3. Homestead 4 Q �• residence? 0 I7g 4.Solar Energy Heating or Cooling o �, nn 2.Does the buyer have a homestead to be vacated 0 l 5.Wind Power Device `" O p or this residence?If yes,provide address: 0 (� 6.Hydroelectric Power Device O -,=o R Addressn(num¢or.a sir et) al 0 (t 7.Geothermal Energy Heating or C evict Z IUnC QO 1. �/� ~i O C .state ZIP code, n count1N m f Q_Qa, / 2� 23-/J-�D 0D2- `Y 4-1 t Under penalties of perjury.I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete eA 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 C`I Page 3 of 5 . CI 0 PY