HomeMy WebLinkAboutHomestead_Bailey (2)H. PREPARER
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Title
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Company
Email Address
Telephone Number
Re Tonal Title Services LLC
closings@regionaltitlellc.com
( 812 ) 759-5555
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Antonio Smith
Leiya (Watanabe) Smith
Address (number and street)
Address (number and street) aut3
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179 E Lake Inwood Drive
179 E Lake Inwood Drive ?426
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
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Country CUtiNNA�Dl
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us
Email Address
Telephone Number
Email Address
Telephone Number
antoniosmith29@gmail.com
( 248 ) 721-5635
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314 ) 940-3992
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.
Signature of Seller
Signature of Seller ,."'
Printed Name of Seller Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mmldd/yyyy)
Antonio Smith 07109/2026
Leiya (Watanabe) Smith
07/09/2026
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
Leah M. Bailey
Neal D. Bailey
Address (number and street)
Address (number and street)
1803 W Midlan Ave
1803 W Midlan Ave
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
us
us
Email Address (1 y,
0
Telephone Number
Email Address
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I
Telephone Number
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( 812 ) 568-4088
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( 812 ) 664-9900
Pursuant to IC 6-1.1-12- 4, the Sales Disclosure Form 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
® ❑ 3. Homestead
residence?
❑ ® 4. Solar Energy Heating or Cooling System
❑ ® 5. Wind Power Device
O ® 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ ® 6. Hydroelectric Power Device
❑ ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
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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
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 LicenseliD/Other Number is necessary only if a Homestead Deduction is being filed.)
"natu,of B er 1 ,.
ignature of B yer 2/Spouse
11)l
066 a Legal Name of Buyer 1 n Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Sp6tAe Sign Date (MM/DD/YY)
Leah M. Bailey 7/9/2026
Neal D. Bailey 07/09/2026
Last 5 Digits of yer SSNj{gers License/ID/Other Number
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Last 5 Digits of Buyer 215pou e S�y�
V (1
License/ID/Other Number
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Page 3
H. PREPARER
P qj the le Is cosh Fo�
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Title
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Title Com an
_
Company
Email Address
Telephone Number
Regionsli Title Services LLC
closings@regionaldtlelle.com
( 812 ) 759-5555
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715
1. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Antonio Smith
Leiya (Watanabe) Smith
Address (number and street)
Address (number and street) & 3
O ��211c
179 E Lake Inwood Drive
179 E Lake Inwood Drive
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country �UtV CUUN4'4' _
us
t_
Email Address Telephone Number
Email Address
Telephone Number
antonlosmith29@gmail.com ( 248 ) 721-5635
( 314 ) 940-3992
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.
Signature of Seller f
Signature of Seller
Printea Name of Seller
Date Signed (mmtddlyyyy)
Printed Name of Seller Dale Signed (mmtddlyyyy)
Antonio Smith
07/09/2026
Leiya (Watanabe) Smith 07/09/2026
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
Leah M. Bailey
Neal D. Bailey
Address (number and street)
Address (number and street)
1803 W Midlan Ave
1803 W Midlan Ave
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
US
us
Email Address
Telephone Number
Email Address I Telephone Number
( 812 ) 568-4088
1 ( 812 ) 664-9900
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Fonn may be used to apply for certain deductions. Identity all of those that apply:
YES NO CONDITION
YES NO CONDITION
® 0 1. Will this property be the buyer's primary
® D 3. Homestead
residence?
0 (N 4. Solar Energy Heating or Cooling System
D ® 5. Wind Power Device
0 ® 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
0 ® 6. Hydroelectric Power Device
0 (Z 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
�}/ _ _ 1a, �� _9�() _ c)o . �{3g a�l
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
transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's
Infomratlon, SSWDrivar's License/fDlOther Number Is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer 1
t ot,iL,(�
_
Signature of Buyer 2/Spouse
C r f U frc i�
Printed Legal Name of Buyer 1 Sign Date (MM/DDIYY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Leah M. Bailey 7/9/2026
Neal D. Bailey 07/09/2026
_
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 21Spouse SSN/Driver's License/ID/Other Number
Page 3