Homestead_Embree r-
I H. PREPARER
; Preparer of the Sales Disclosure Form Title
Kristina Watson Settlement Agent
Company E-mail address
Address(number and street city.state,country,and ZIP Code)
4799 Rosebud Lane,Newburgh,IN 47630
E I.SELLERS)/GRANTOR(S)
i"-Seller 1-Name as it ap
pears on conveyance document Seller 2-Name as appears on 7 •• nt .
Harold N.Wolf
Address(number and street) Address(number and street) MIN405 S.Victor St. - NOV �&2022
City,state.and ZIP Code City.state.and ZIP Code 11110/
Fort Branch,IN 47648
Country I Country tRG( a- ,za.)--3
US GIBSON COUNTY AUDITOh
E-mail address
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.
Signatu of Seller Signature of Seller -
Printed Name of Sellerit. (/ :Late signed(m nickli yyy) Printed Name of Seiler Date signed(mm/dd/yyyy)
Harold N.Wolf i Q 122 11/08/2022
J. BUYER(S)/cRANTEE(S)-APPLICAii6k 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
Nathan C.Embree Denise Wilson
Address(number and street) Address(number and Street)
405 S.Victor St. 405 S.Victor St.
City,state,and ZIP Code City,state.and ZIP Code
Fort Branch,IN 47648 I Fort Branch, IN 47648
Country Country
US US
E-mail address
-.
YES NO CONDITION YES NO CONDITION
i 4- Q I.Will this property be the buyer's primary 0 3. Homestead
�" residence? 0 ® 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 Q 5,Wind Power Device
for this residence?If yes,provide address: 0 Gil 6.Hydroelectric Power Device
-
Address(number and street) 0 CA 7_Geothermal Energy Heating or Cooling Device
i
City,state.ZIP code.and county O ��
_ )U-1� - 2-2/01 - H2O - . - oz 6.
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and better.is true,correct and complete
`)
Page 3
COPY