Homestead_Miskell-Frederick H. PREPARER
Preparer of the Sales Disclosure Form Title
Kristlna 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 on conveyance document
William C. Fortner Jonathan L.Fortner
Address(number and street) Address(number and street)
116 E.Olive Dr. 116 E.Olive Dr.
City,State,and ZIP Code City,State,and ZIP Code
Princeton,IN 47670 Princeton, IN 47670
Country Country
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 falsifies any information required to be provided,commits a Level 5 felony.
Signature of
Seller Si nature of S er
v�l
Printed Name of Seller Date Signed(mm/dd/yyyy) Pdi eC d Name of Seller at - . .(mm/dd/yyyy)
William C.Fortner 05/17/2024 Jonathan L.Fortner 0
�_
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 o v cQagqumentS
LaSheila M.Miskell-Frederick Monte D. Frederick ���L7� n�/
Address(number and street) Address(number and s t) • �/ C
328 E. Oak St. 328 E.Oak St. Gigs ON • -�- " '
City,State,and ZIP Code City,State,and ZIP Code COUNTy ,,
Princeton,IN 47670 Princeton,IN 47670
N , Country Country
0 US US
i 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:
V YES NO CONDITION YES NO CONDITION
O 1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 ® 4. Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 al 5.Wind Power Device
t X O
for this residence? If yes, provide address: Q ® 6. Hydroelectric Power Device
0 Address(number and street �� 0 ® 7. Geothermal Energy Heating or Cooling Device
(Ni) l t S -Yeses
City,State,and ZIP Code n - County
Sao irivet,4.•i• -�-t WIkilo L( 5d� 26-IZ- L U�l- �02 _Oil- -b2 , ^�
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
(-NJ 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
t Information,SSN/Driver's License/ID/Other Number is necessary only If a Homestead Deduction is being filed.)
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