Homestead_Gwaltney H. PREPARER
Preparer of the Sales Disclosure Form Title
Cody L Pruett Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears v trance document
Gibson County Holdings, LLC 4.4.,
Address(nu
mber d street) Address(number and street)
16 C1 Ste i'u sV- '�2100rJ i. or
City,state,and ZIP Code /s.
��� City,state,and ZIP Code C ,,8 "�
Countryt1 Country G� S • P
C )
i O
12
E-mail address
my knowledge and belief,Is true,c eot 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 omi or falsifies any Information required to be provided,commits a Level 5 felony.
Si, Her ' Signature of Seller
—"Tint- " erne of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
_ Gary K. Smith; Member Id,- I ,20 a). , 20_
J. BUYERS)/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 on conveyance document
Rebecca Gwaltney Jeremy Staley
Address(number and street) Address(number and street)
1 3c CJ G1LX.r - --N-1 S\ '
City,state,and ZIP Code City,state,and ZIP Code
JCAk-tti3OCA (_A 1. `livtp0
Country Country C..�•
that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary 11-51 0 3. Homestead
17( ❑ residence? 0 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 5.Wind Power Device
CIfor this residence?If yes,provide address: 0 8.Hydroelectric Power Device
Address(number and street) ❑ 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county -114 -1 W-L( 0 3 -bo 0• 839 -go/-
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 8-1.1.5.5.A person who knowingly and Intentionally falsifies the value of
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