Homestead_Embry H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company Email Address Telephone Number
Hometown Title.LLC orders@hometowntitles.com ( 812 ) 461-6399
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1—Name as tt appears on conveyance document Seller 2—Name as appears on e yaiPd nt
Viola L.Johnson Family Trust dated March 12,2021
Address(number and street) Address(number and street) ��1236 S Gibson St, 1")��I / G� hS ht' +A qN
City,State,and ZIP Code L '+ / City,State,and ZIP IS `` �
Princeton,IN 47670 L�VA►'}5Yi 11 e) .i1N '7 TM <6, o _ y
Country Country , Q
US Gtiry,�
Email Address Telephone Number Email Address q� Telephone
(Y/Z � s) Loy Z '—a� ir )
Under penalties of penury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true, rrect,and complete as
required by law,and Is prepared In accordance with IC 6-1.15.5.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.
Sig ler Signature of Seller
Prin of Seller Date Sig ( m/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Rl G.Johnson, li577,Y
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 tt appears on conveyance document
Anthony AP Embry
Address(number and street) f�j_� Address(number and street)
¢46 0-&-TaraLane:. )�--'r `j (- ;
City,State,and ZIP Code City,State,and ZiP Code
F .i7.'tn,C,f r`V;'-\ , i ;N ) t/2 14, J‹:'
Country Country
US
Email Address Telephone Number Email Address Telephone Number
( /2.)6y i "`t9t 5 ( )
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
® O 1.Will this property be the buyer's primary ( 0 3.Homestead
residence? 0 Ci5 4.Solar Energy Heating or Cooling System
O • 2.Does the buyer have a homestead to be vacated 0 ( 5.Wind Power Device
for this residence?If yes,provide address: O ® 6. Hydroelectric Power Device
Address(number and street) 0 ( 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County -"4 b - I L- i , --k93 -0 01- 34. 4 - p 2g
Under penalties of perjury,i hereby certify that 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 required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSA/Driver's UcensdiLVOther Number Is necessary only Na Homestead Deduction Is being filed.)
S to Buyer 1 Signature of Buyer 2/Spouse
,.,
Printed Legal Na of Buyer 1 Sign Da (M DM') Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YY)
Anthony AP Ernb 4/5/if
Last 5 Digits of Buyer 1 s Ucense/iD/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's licenseAD/Other Number
ti
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