Homestead_Smith (51) 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
Douglas J.Yeryar Kimberly S. (Yeryar) Blaize
Address (number and street) Address (number and street)
2326 E SR 64 7580 N 450 E
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Hazleton, IN 47640
Country Country
United States of America United States of America
Email 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.
of Selle Si atur of Seller
c41
����6ameo Seller Date signed (mm/dd/yyyy)
Nam of Seller Date signed (mm/dd/yyyy) Printed 9 ( yyyy)
Douglas J. Yeryar 2/14/2024 Kimberly S. (Yeryar) Blaize 2/14/2024
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
Garry R. Smith,Jr.
Address (number and street) Address (number and street)
2150 Fosters Way FILE D
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America FEB 1 6 2-024
YES NO CONDITION YES NO CONDITION
2 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead
0 2 4. Solar Energy Heating or Cooling System
0 2 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device
this residence? If yes, provide address:
❑ Ll 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county t _/ Oa) 3c/3.O ?
3