HomeMy WebLinkAboutHomestead_Johnson (2)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Kelly E Norton
Settlement A ent
Company
Email Address
Telephone Number
Bosse Title Company
( 812 ) 421-4000
Address (number and street, city, state, country, and ZIP Code) --
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Jonathan D. Smith
Peggy D. Smith
Address (number and street) Address (number and street)
5809 Lake Shore Dr. 5809 Lake Shore Dr.
City, State, and ZIP Code City, State, and ZIP Code
Boonville, IN 47601 Boonville, IN 47601
Country Country
US US
Email Address Telephone Number Email Address I Telephone Number
peggydewig@hotmail.com ( 812 ) 550-2513 ( 812 ) 202-1373
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 bylaw, 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, c9mikits a,Vevel 5 felony.
SicLature of Seller ! ;
• - 0 ------
_
Signature of.Seller
I,
Pr(hted Name of Seller
Date Signed (mmlddlyyyy)
Printed Nat' o Seller Date Signed (mm/dd/yyyy)
Jonathan D. Smith
07/20/20;
Peggy D. Smith 2W6
J. BUYER(S)IGRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY AL A PL
�! Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on conveyance documen
4, Adam Johnson __ _
Erin Johnson
l Address (number and street)
Address (number and street) - -
1218 Raleigh Dr.
1218 Raleigh Dr. e
City, State, and ZIP Code
' City, State, and ZIP Code
Evansville, IN 47725
( Evansville, IN 47725
Country
Cus ountry BSpN CO[JNjYAUp)�
Email Address
Telephone Number
Email Address
Telephone Number
adamj@mcgowninsgrp.com
( 812 ) 664-3376
(b/d- )&&C( 3 S7
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Forth may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1. Will this property be the buyer's primary ® O 3. Homestead 1
® �
residence?
O ® 4. Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated D ® 5. Wind Power Device
for this residence? If yes, provide address: p ® 6. Hydroelectric Power Device
Address (n.4mber;;ndFstr�et)^ /_ �• 0 ® 7. Geothermal Energy Heating or Cooling Device
Ci-6tate, and ZIP Code County / - -1 � _ —,-) QC - Qo\ � �' ,:0
I"ilCy�lSUr ��e, !IV �7 ? a CX LJ�J
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 6-1.15.5. 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, SSWDriver's License/ID/Other Number Is necessary only if a Homestead Deduction is being filed.)
Signatur of uyer 1
Sig�r aturg o uyer 2/Spouse
__ `�
p y
Printed Liagal Name of Buyer 1 Sign Date (MM/DD/YY)
Ffinted lev gal Name of Buyer 2/Spouse Sign Date (MWDD/YY)
Adam Johnson 7/20/2026
Erin Johnson 07/20/2026
Last 5 Digits of�Buy6er 1 SSN/ Dn'ver's Lice nse+li /OtheA{lumber i
p - • —
Last 5 Digits of Buyer 2/S SSNIDrivers Licens�llD Cher Number
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