Homestead_Long H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave„Suite 102, Evansville, IN 47714
I.SELLER(S)(GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Kirk, Odom Kyra Marie Odom
Address(number and street) Address(number and street)
210 South Lincoln Street 210 South Lincoln Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch IN 47648 Fort Branch IN 47648
Country
USA Country
USA
1
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
-ig�alur v Seller
i$Iona tire of Seller �Q►-�
Printed Name of Seller t~ �"
Da signed(mm/ddryyyy) Print ame of Seller Date signed( middlyyyy)
Kirk p(IeOdom 1,Dag
Kyra Marie Odom 8/jr 22c
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 co eyance document
Erin Katherine Long
Address(number and street) Address(number and street) IQ
511 North Polk Street City,state,and ZIP Code City,state,and ZIP Code )'�Fort Branch IN 47648Coun A ( ]
USAF Country 460 / -�,J
USA U 3
for certain deductioneicikt
YES NO CONDITION Ii th9sythatapply:
YES NO CONDITION U�j� j//¢¢—•��
CI 0
1.Will this property be the buyer's primary O 0 3.Homestead Ato,, of
residence? O
0 O 4.Solar Energy Heating or Cooling System
to/Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence?If yes,provide address: 0 l 6.Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,slate,ZIP code,and county
26— I T- u-koi - ooI . 0g6-02_G
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
,,c^,��s,x 4r1
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, H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company E-mail address Telephone number
Regional Land Title Company Kris@Regional-LT,com (e12)402-0553
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave.,Suite 102, Evansville, IN 47714
I.SELLER(S)IGRANTOR(S)
Seller 1—Name as It appears on conveyance document Seller 2—Name as appears on conveyance document
Timothy Wayne Smith Tana Lee Smith
Address(number and street) Addtesc,rum er street)
•
City,slate,and ZIP Code City,state, ZIP de
Q'R k.S \\e .S y-\ 4 i lti V)5
Country Country
USA USA
E-mail address Telephone number E-mail address Telephone number
tim,smith@sgibson.k12.in.us ( 12 '1ti'7 smithtona@gmall.com 1 �`
� �� � �iv4�o�— 3�S
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.
Siury of Seller ^ St alum of Seller
Printed Name of, lier 1'�A \�\\l Date signed(mm/dd/yyyy) Printed Name of Seller \r1, Date signed(rnmfdd/yyyy)
Timothy Wayne Smith Tona Lee Smith
J.BUYER(S)1GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIF A HAT APPLY
Buyer 1—Name as It appears on conveyance document Buyer 2—Name as It appears on e ment
- L)
Address(number and street) Address(number and street)
///�j
City,state,and ZIP Code City,state,and ZIP Code 46,
Country Country () 13 202 -
USA USA Q'/6s s
E-mail address Telephone number E-mail address °' Co,Q T ephone number
( ) //Ir7:), )
Pursuant to IC 6-1.1-12.44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all pply:
YES NO CONDITION YES NO CONDITION 0,9
O O 1.WIII this property be the buyer's primary 0 0 3.Homestead
residence? 0 0 4.Solar Energy Heating or Cooling System
O 2.Does the buyer have a homestead to be vacated 0 0 5.Wind Power Device
for this residence?If yes,provide address: 0 0 6.Hydroelectric Power Device
Address(number and street) 0 p 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
26-1?-13 --40i - 001 . 086—OLG•
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
Information,SSN/Driver's License/ID/Other Number Is necessary if a Homestead Deduction Is being Rfed.)
Signature of Buyer 1 Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date(MM/OD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date(MMIDD/YY)
Last 5 Digits of Buyer 1 SSN/Driver's License/lDiOlher Number Last 5 Digits of Buyer 2/Spouse SSN/Drivers License/ID/Other Number
is..:
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