Homestead_Wilson H. PREPARER
Preparer of the Sales Disclosure Form Title
Kristina Watson Settlement Agent
Company Email Address
Address(number and street,city,state,country,and ZIP Code)
4799 Rosebud Lane,Newburgh, IN 47630
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears •- - - -.ce document
Michael Curtis WilcoxII I
Address(number and street) Address(number and street) 11/
110 E.Rock Rd.
City,State,and ZIP Code City,State,and ZIP Code SEP 12 2023
Owensville,IN 47665 (\\
I Country Country
US -
GIBBON COUNTS AUDITOR
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 innnform/atioon required to be provided,commits a Level 5 felony.
S�i9natur Ile�� ( � "i-tf L'(/L�"� Signature of Seller
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Michael Curtis Wilcox 09/08/2023 09/08/2023
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
Michael Ray Wilson Connie J.Wilson
/ ' Address(number and street) Add �( mb r and street)
SS, k RamWr
i City,State,and ZIP Code City,State,and ZIP Code
�'-nJ0-/*S D -FA) '/76'9
Country L Country
US US
Email Address
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
a 1.Will this property be the buyer's primary 1:1 0 3. Homestead 4
residence? /resence \ e� �
r 0 1 IX 4. Solar Energy Heating or Cooling System caM j
0 O 2. Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device b tin •
O K for this residence? If yes, provide address: 0 IX 6. Hydroelectric Power Device n0
Address(number and street) s V
o S 53 S � J L O ® 7. Geothermal Energy Heating or Cooling Device
_ '2.(2G Qp (.o ! '
r City,State,and ZIP Code County
6-1 rrat7C)5CD Tin (nut( 1- bin a6-tg -ot -33 _0 0 u .4- 2-6 _0 2 -
I Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct,and complete
ell
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