Homestead_Gerlach 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
Kurtis Dean Williamson Carrie Ann Williamson
Address(number and street) Address(number and street)
9293 S.225 W 9293 S 225 W
City, State and ZIP Code City, State and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
United States of America United States of America
E-mail address
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.
Sign Xure Sellera / e �., Signa re of Seelllerit
'ov0) )
Printed Name of Seller Date signed(�m/dd/yyyy) Printed Name of Seller Date si ned m/dd/yyyy)
Williamson Kurtis Dean (2,-`I 2 / Carrie Ann Williamson I Z I1-7 1 2--/
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY p'PPPLLY
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it app s o o eya<c-, ent
Jenna Gerlach /
Address(number and street) Address(number and street)DEr
603 S 9th Avenue 2 8 202,
City,State and ZIP Code City, State and ZIP C,�
Country Haubstadt, IN 47639 G/QSn/y GUU A� 1��
Country - T+a/
United States of America OR
E-mail address
apply for certain deductions. Identify all of those that apply:
Y NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary residence? f ❑ Homestead
0 � f4. Solar Energy Heating or Cooling System
0 LW 2. Does the buyer have a homestead to be vacated for ❑ Wind Power Device
this residence? If yes, provide address: ❑ ydroelectric Power Device
Address(number and street) 0 7. Geothermal Energy Heating or Cooling Device
City,State, and ZIP Code County
.5..l.e — lh' — a.Q• -co-tDa (. 84" .-aa�
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and