Homestead_Gross I .
H. PREPARER !
Preparer of the Sales Disclosure Form Title
Matthew Jarvis I Escrow Officer
Company I
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) I
Seller 1—Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Camryn E.Smith I
Address(number and street) Address(number and street)
6693 N SR 65
City,State and ZIP Code City, State and ZIP Code
Hazleton, IN 47640
Country I • Country
United States of America
Email Address
A� U6 9
Under penalties of perjury,I hereby certlfy this Sales Disclosure,to the best of my knowledge and lef,is true,correctomplete as required
by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentional) f the value of transferred real property,or
omits or falsifies any information required to be provided,commits a Level 5 felony. IeSON cr, ' / l<
Signature of Sell e Signature of Seller N•
Ty
Printed Name of Seller Date Signed(mm/ddl Printed Name of Seller ¶ ate Signed(mm/dd/yyyy)
Camryn E.Smith I 8/15/2025y
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
Isaac B. Gross
Address(number and street) Address(number and street)
1649 Lincoln Pass!
City,State and ZIP,Code City, State and ZIP Code ,
Haubstadt, IN 47639 ,
Country I Country
United States ofArnerica
Email Address 1
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 0 1. WII this property be the buyer's primary residence? 0 0 3. Homestead
❑ 0 2. Does the buyer have a homestead to be vacated for 0 0 4. Solar Energy Heating or Cooling System
this residence? If yes,lprovide address: 0 0 5. Wind Power Device
Address(number and street) 0 0 6. Hydroelectric Power Device
i ❑ 0 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County •P6-OS-G/-4Oa--c 5. 36, --0/7
Under penalties of perjury,I hereby ceirtify 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
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