Homestead_Smith (87) H. PREPARER Preparer of the Sales Disclosure Form Title
Shelby Head Closing Agent
Company
Address (number and street,city,state, country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears o con y e document
G&K Properties LLC
Address(number and street) Address(number and street)
P.O. Box 8040 '�l/t
City,State,and'ZlP Code City,State,a Code fJ
Evansville, IN 47716 ies180-
o �Q
Country Country tiC,
USA qGQ,.�/
E-mail Address
of my knowledge and belief,isstrue,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.
Sig f re:of Seller Signature of Seller
re.
Id''
Pnnt d Nam of Selle Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Grant Alvey Waldroup, Member July 13, 2023 July 13, 2023
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 it appears on conveyance document
Jerrick L. Smith Jenna N. Smith
Address(number and street) Address(number and street)
529 South Seminary Street 529 South Seminary Street
City,State,and ZIP Code City,State,and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
USA USA
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary ❑X ❑ 3.Homestead
0 ❑ residence? ❑ Ei 4.Solar Energy Heating or Cooling System
� 2.Does the buyer have a homestead to be vacated El ❑X 5.Wind Power Device
Elice. for this residence? If yes, provide address: ❑ 0 6.Hydroelectric Power Device
Address(number and street) ❑ X❑ 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County
a6.12- 01- 3 -00 0 . 412-o •
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
Ryk
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