Homestead_Robinson (8) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kelly E Norton Settlement Agent
Company Email address
Address(number and street,city,state.country,and ZIP Code)
4799 Rosebud Lane, Newburgh,IN 47630
1. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2—Name as appears on Conveyance document
Heirs and devisees named under the Last Will and Testament of Michas ---
Address(number a d street) ` Address(number and street)
/16if - i -- -_
U + J _ City,state.and ZIP Code
4 �t -L.i (fd t? 1. AS
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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.
Signature of Seller Signature of Seller
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Pri ed Name Seller I Date signed Cm datryyyy) I Printed Name of Seiler Date signed(mmldd/yyyy)
Judy Frederick, 11/30/2022 ` 11/30/2022
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
Macray Jorgen Robinson tali,
D
Address(number and street) Address(number and street) FT T J .- .202 S. Hillcrest St. 1 ` .-'.
sty,state,and ZIP Code City,state,and ZIP Code
Fort Branch,IN 47648 (..-_---'3 *—
__.. nF1- 0 7 2022
Country Country S
y�z Nptte ri�aei
for certain deductions.Identify allot those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary 1 CO 0 3.Homestead
® O residence? D Oil 4.Solar Energy Heating Or Cooling System
2.Does the buyer have a homestead to be vacated O ( 5.Wind Power Device
xresidence? If for this resence yes,provide address: p GI 6.Hydroelectric Power Device
Address(number and street) p al 7.Geothermal Energy Heating or Cooling Device
City.state,ZIP code:and county Gl/ 1 S _`3 -
I `O\_O OO / / O _ O 2G
Under penalties of perjury,1 hereby certify that this Sates Disclosure,to the best of my knowledge and belief,.is true,correct and complete
Last 5 Digits of Buyer 2/Spouse SSN/Driver s License/ID/Other Number
COPY