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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
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