Homestead_Hoefling (4) I H. PREPARER
Preparer of the Sales Disclosure Form i Title
Kristina Watson Settlement Agent
Company
Bosse Title Company -_ -
Address(number end street,city,state.country,and ZIP Code)
4799 Rosebud Lane,Newburgh,IN 47630
I.SELLER(S)/GRANTOR(S) --
Seller 1-Name as it appears on conveyance document I Seller 2-Name as appears on conveyance
Daniel L.Scott,Jr. Margaret M.Scott
Address(number end street)
Address(number end street) O`
12_8 E.795 S. —__ _128 E.795 S. r�Q
City,stale.and ZIP Code City.state,and ZIP Code �'. . - e
'16
Fort Branch,IN 47648 Fort Branch,IN 47648 _ O4, 1
O
Country Country 4,
US US _
transferred
real property,or om'ts or falsifies any Information required to be provided,commits a Level 5 felony.
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ignat of eller
Printed Name of Sell • �W' Date si edcOrun/fdd/yyyy) Printed Name- Seller to signed(mm/ddNYYy)
Daniel L.Scott,Jr. j 11/23/2022 _ Margaret M.Scott 11/23/2022
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
Mello A.Hoeflin! Joshua M.Hoefling __
Address(number end street) Address(number and street)
102 S.Weber Dr. 102 S.Weber Dr.
City,state,and ZIP Code �.^ mm mm City.state,and ZIP Code
Haubstadt, IN 47639 Haubstadt,IN 47639
Country Country
US US
YES NO CONDITION YES NO CONDITION
X( 1. Will this property be the buyer's primary 0 3.Homestead
.
O residence? O ® 4.Solar Energy Heating or Cooling System
0 )( 2. Does the buyer have a homestead to be vacated 0 a 5.Wind Power Device
for this residence? If yes,provide address: 0 al 6.Hydroelectric Power Device
Address(number and street) O ® 7.Geothermal Energy Heating or Cooling Device
City.state.ZIP code,and county b 1 .Z - O Z
�6-\�-t�-23-
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the beat 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
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copy