Homestead_Simpson (3) H. PREPARER 1
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Manager
Company
' Address(number and street,city,state,country,and ZIP Code)
101 Plaza E. Blvd. Suite 102 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 1
Kenneth Simpson Debra Simpson
Address(number and street) Address(number and street)
IN,,ID WART• 1-I.,11 R.o_c,d \lyyC v\(‘\ re Nil► 0
City,State,and ZIP Code City,State,and ZIP Code
.yu�ti1 ,T.A/ 91 33 _ �Po?y v\ 11-t A[ &--)cf, 3
Country Country
Email Address
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 Isifles any Information required to be provided,commits a Level 5 felony.
Slgnbture of Seller / .►.'atur of Seller
�Firiipted`iVa�nie=b151 er- , " Date Signed(m dd/yyyy) litulame .f Seiler L� Date Signed mm/dd/
Kenneth Simpson g ( )
p '�-3 - �,� Debra Simpson '7_3_Z,3
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
Frank Simpson 1,J c1C61e s f y SOfl
Address(number and street) AddresA(number and street)
8902 South Meadow Lane plq Or L S M-egd ow L .
City,State,and ZIP Code City,State,and ZIP Code /( I,
Owensville, IN 47665 O r S'dt ( . \N 41 Q(D(
Country Country
Email Address
YES NO CONDIT YES NO CONDITION
o 1.Will this prope �y imary ❑ 0 3.Homestead
residence 0 p 4.Solar Energy Heating or Cooling System
{ ❑ 2.Does the bueilav homestead to be vacated 0 O 5.WInd Power Device
fhis residence? If Aidarovrde address: ❑ 0 6. Hydroelectric Power Device
Address(numRiQ� Q 0 Q 7.Geothermal Energy Heating or Cooling Device
'VCCity,State,and ZIP Code O�N County
4UOlino
� CK0-rl-Agl-a00- 0a 1. SI7-ate`
Under penalties of perjury,I hereby certify that 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.(Note:Both spouse's
ccY