Homestead_Emerson (2) H. PREPARER
Preparer of the Sates Disclosure Form Title
Stacey Salzman _ Settlement Agent
Company
Address(number and street,city,stale,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I. SELLER(S)IGRANTOR(S)
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document
Jaime L.Emerson _Address(number and street) Address(number and street)
124 S.Washington St. --
City,state,and ZIP Coda City,state,and ZIP Code
Princeton,IN 47670
Country Country
US ---
E-mail address
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.
S` nature of Seller Signature of Seller
�l 2 C( -- -Z--L
PrInteiName of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmIddlyyyy)
Jaime L.Emerson 12/30/2021 12/30/2021
J. BUYER(S)IGRANTEE(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
Jenny Lynn Emerson
Address(number and street) Address(number and street)
124 S.Washington St.
City,state,and ZIP Code City,state,and ZIP Code
Princeton,IN 47670
Country Country
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION Eli
VD 0 I.Will this property be the buyer's primary (Xi 0 3.Homestead z COpli
residence? 0 ($1 4.Solar Energy Heating or Cooling SYg rz, I--I
43
2.Does the buyer have a homestead to be vacated 0 19 5,Wind Power Device z o ti
0 (lcfor this residence? If provide address:
yes,
(� (� 6.Hydroelectric Power Device , to el
Address(number and street) 0 (2) 7.Geothermal Energy Heating or Coo4 ce
Ci • -
County zi
City,state,and ZIP Code 26-12-08-301-002.329-028 W
Under penalties of perjury,I hereby certify that this Sales Oiactosure,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