Homestead_Johnson (27) H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310, Evansville, IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Amber Simmons
Address(number and street) Address(number and street)
610 E. State St.
City,State,and ZIP Code City, State,and ZIP Code P14
Princeton, IN 47670 J�j�
Country Country �T
US 4/A
Email Address
(?;7 '
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge an. " '• 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 intentio tuyiiii the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. /Li-j, %may
S 'nature of Seller r-� Signature of Seller 4(�O/
'0,9 c.s ,?'
P777riirrt e��'d�Na"me of Seller Date Sign d(rnm/ d/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy
Amber Simmons Ce 13
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
Travis C.Johnson
Address(number and street) Address(number and street)
610 E. State St
City,State,and ZIP Code City,State,and ZIP Code
Princeton, IN 47670
Country Country
US
Email Address
( )
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 YES NO CONDITION
al1.Will this property be the buyer's primary ® 0 3. Homestead
residence? 0 121 4.Solar Energy Heating or Cooling System
/2. Does the buyer have a homestead to be vacated 0 ( 5.Wind Power Device
for this residence? If yes,provide address: 0 ® 6. Hydroelectric Power Device
Address(number and street) 0 12 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
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
5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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