Homestead_Stoldt (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
Address(number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Home Smith Home LLC
Address(number and street) Address(number and street)
1497 E Taftown Road
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America
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.
,atu Selle Signature of Seller
rinted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Dwight"Matt" Smith, Member 6/24/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 —Names it appears on conveyance document Buyer 2-Name as it appears on c tnTe doCrieD
nstian Stoldt 1 J ■�--1/
A dress(number and street) Address(number and street)
5?410 Wi(oll�'r Lam- JUN 2 9 2022
City, State and ZIP Code City, State and ZIP Code
• Ma roc Cc .17d- ¢7 SS sy,
Country I Country 'VhzGIB zez.e/UNT.// D� J
United States of America
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 �YE NO CONDITIO
1� El 1. Will this property be the buyer's primary residence? It 0 3 Homestea
0 l 4. Solar Energy Heating or Cooling System
❑ IKl72. Does the buyer have a homestead to be vacated for ❑ El 5. Wind Power Device
this residence? If yes, provide address:
❑ El 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code,and county
a 67-/G -o�-Yo3 _ aoo . 0Ss
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