Homestead_Gray H. PREPARER
Preparer of the Sales Disclosure Form Title
Jeffrey H. Bosse Settlement Agent ___-,___- -_� �,_ �._
Company E-mail address
Bosse Title Company
Address(number and street,city,stale,country,and ZIP Code)
4799 Rosebud Lane,Newburgh,IN 47630
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
David A.Cueto Jane A.Cueto
Address(number and street) Address(number and street)
8134 S.Victoria Dr. 8134 S.Victoria Dr.
City,state,and ZIP Code City.state,and ZIP Code
Fort Branch,IN 47648 Fort Branch, IN 47648
Country Country
_US US
E-mail address
( )
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 Sell Signature of Seller
-- YYYY
Printed Name of Seller Date signed(mmldd/yyyy) Printed Name of Seller Date signed(mm/dd1 )
David A.Cueto 10/21/2022 Jane A.Cueto 10/21/2022
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
Jeffrey D.Gray F
ILE D
Address(number and street) Address(number and street)
8134 S.Victoria Dr.
City,state,and ZIP Code City,state,and ZIP Code OCT 2 4 2022
Fort Branch,IN 47648
Country Country _
US //ems2eC? ., a. J�?Y-44ur"''
E-mail address
to apply for certain deductions.Identify all of those that appl!y:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary El 3. Homestead
ElO residence? 0 ID 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 f 5.Wind Power Device
0 for this residence?If yes,provide address: 0 134 6.Hydroelectric Power Device
Address(number and street) 0 IN 7.Geothermal Energy Heating or Cooling Device
City,slate,ZIP code,and county ‘^lg c�L)-- tO 1 -00 0 -Q-T3^O 2._
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