Homestead_Heldt (5) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D. Gibbs Escrow Officer
Company
Address(number and street,city, state,country,and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Kris Allan Crowder
Address(number and reet) Address(number and street)
8751 S 1025 W ,6-7
City,State and ZIP Code City, State and ZIP Code
Owensville, IN 47665 v r/1` i lC1v ` 1kc)
Country t Country
United States of America
E-mail address address Telephone number
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 required to be provided, commits a Level 5 felony.
Sig re of S l7 I%Qe (�!} //J�, Signature of Seller
Il C�of Se le ()Jill A(�S/"'�
Printed Name of Seller Date aigned,(mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
Kris Allan Crowder ;1 136 J Q
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 appear r 1 or, inr J yan"leaf�ont
Bryan Heldt I—i
Addres nAm4ei and Street) C VV Address(number and street)
`D City, State and ZIP Code DEC 0 8 2021
City,State and ZI Code
IN 0 W`�4\-`Vf 11(2._ ' L4 )kQ k)7 S ,
Country Country GIBSON COUNTYD
United States of America
E-mail address E-mail address Telephone number
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:
;ErNO CONDITION YES O CONDITION
0 1. Will this property be the buyer's primary residence? ❑v 3. Homestead
❑ 4. Solar Energy Heating or Cooling System
0 �2. Does the buyer have a homestead to be vacated for ❑ f� Wind Power Device
this residence? If yes, provide address: o Hydroelectric Power Device
Address(number and street) 0 7. Geothermal Energy Heating or Cooling Device
90-11_ag-Ioo-czO.56/-oa I
City,State,and ZIP Code County