Homestead_Wilson (11) H. PREPARER
Preparer of the Sales Disclosure Form Title - -,
Claire Kincaid Settlement Agent
Company , .
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2- Name as appears on conveyance document
David M. Fortune Victoria Sue Fortune
Address (number and street) Address (number and street)
11604 S. 350 E. 11604 S. 350 E.
City, State, and ZIP Code City, State, and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country
US _ US
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 , ope , or omits erlalsifies any information required to be provide_ commits a Level 5 felony.
• '; •• , - ler '`i nature of Seller
P nted Name of Seller Date Signed (mrn/dd/yyyy) (Pri ed Name of Seller Date Signed (mmlddlyyyy)
&avid M. Fortune - • 11/2025 Victoria Sue Fortune 09/11/2025
J. BUYER(S)/GRANTEE(S) - APPLI 0 F - PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance d• :i Buyer 2 -Name as it appears on conveyance document
David Wilson _ Melanie Wilson
Address (number and street) Sep Address (number and street)
11604 S. 350 E. J b' 11604 S. 350 E.
City, State, and ZIP Codes City, State, and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country "�/V Country
US ������ US
YES NO CONDITION YES NO CONDITION
(-1 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 (l 5. Wind Power Device
for this residence? If yes, provide address:
O ® 6. Hydroelectric Power Device
Address (number and street) Q GEI 7. Geothermal Energy Heating or Cooling Device
319 E 1025 s 26. -(9 -3} -4 00 -o00. '3 26 .02 •
City, State, and ZIP Code County a L r'- J _I 1 _ ,O0` O. 2_ scis .... 0 Zl\Haub , IN 47639
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
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