Homestead_Guzman Jr H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis 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 Rd.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 '
Country
Country
United States of America
E-mail address _
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.
S. r of S err�� /� Signature of Seller
�er _�`j Date signed(mm/dd/yyyy) Printed Name of Seller �G ate signed(mm/dd/yyyy)
ik
Prin a ame of Seller g
Dwight"Matt" Smith, Member 6/30/2022 CAA
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFYC4L THAT AtiPLY
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appear nve4,se do t
Rafael Guzman,Jr.
Address(number and street) Address (number and street) 9G, C-___-)
104 Sycamore St. Qp
City, State and ZIP Code City, State and ZIP Code
Washington, IN 47501 '
Country
ountry
United States of America
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
El ❑ 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
❑ El 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device
this residence? If yes, provide address: 0 p 6. Hydroelectric Power Device
Address(number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
96 -/a-o?— 1 ,63—C,c>1 - Z - o:5'