Homestead_Greubel (5) H. PREPARER
Preparer of the Sales Disclosure Form Title
Claire Kincaid Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4799 Rosebud Ln., Newburgh, IN,Warrick, 47630
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document I Seller 2—Name as appears on conveyance document
Harold Staggs David Staggs
Addr sa( beend street}_ d r s ber an s t/�
C' at nd Q1i-� jn neriQI-
s5COd
• I 4T125 it and hv,/� /Ir T.7Y, I g
ountry //
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.
Signat Sof S e Si n lure of Se ler
Pri a Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Harold Staggs )8/25/2023 David Staggs 8/25/2023
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY L THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conve ment
Amy C Greubel
Address(number and street) Address(number and street)
3607 Furlong Dr City,state,and ZIP Code City,state,and ZIP Code [+`'Flp ,
41
Evansville, IN 47725 6
Country Country • Ze?�
USA 0/eS y
Disclosure Form may be used to apply for certain deductions.Identify all of th/ ply.
YES NO CONDITION YES NO CONDITION '�9
X
❑ 1.Will this property be the buyer's primary x ❑ 3. Homestead
residence?
0 g 4.Solar Energy Heating or Cooling System
g ❑ 2. Does the buyer have a homestead to be vacated ❑ ' 5.Wind Power Device
for this residence? If yes,provide address: 0 tg 6.Hydroelectric Power Device
d re s mb d st t '^
rib i `/� n ❑ 7.Geothermal Energy Heating or Cooling Device
astjte,ZIP code, d coun Y� V�� 2 - lq-11--3o- -0 rn 0 o'
s� ��'� l l 4-1. 125 vohael/ btrr ` .
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of #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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