Homestead_Gibson H. PREPARER _
Preparer of the Sales Disclosure Form Title
Cody L Pruett Closing Agent
Company
Address(number and street city,slate,country,end ZIP Code) —'
4600 Washington Ave., Suite 102, Evansville, IN 47714
I.SELLER{S)It3RANTOR(S) —
Seller 1—Name as It appears on conveyance document Seller 2—Name es appears on c anee d r
Sandra Berkley _
Address(number and st et Address(number end 8be41
Cl fate,and ZIP ode ��- ) City,state,an Code 4023
c_.3\Country / Country S'ON
CoU
E-maVl revs
my knowledge end belief,Is truQ&rrect and complete as
required by law,end I.prepared In accordance With IC 6-1.1.5.6.A parson who knowingly and Intentionally falsifies the value of transferred
real property,or omits or falsifies eery Information riniffod to be provided,commits a Level 5 felony.
Sign• xe of ,Bel 61:14023_
Signature of Seller
Printed Name of Seller •Dalnddyyyy) Printed Name of Seller .� Date signed(mmtdd/yyryry)
Sandra Berkley
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 on conveyance document
Taya Gibson
A ass(number and atree0 Address(number end sheet)
sip 4 ZIP fgdo City,state,and ZIP Code
ry7z Country
E-mail:
-mail dress Telephone numbero —
( )
Pursuant to IC 6.1,1.12.41,the Safes Disclosure Form ma be used to a for certain deductions.Identify eh of those that emir.
YES NO CONDITION YES NO CONDITION
❑ 1.WIII this property be the buyer's primary 0 3.Homestead
residence? 0 0 4.Solar Energy Heating or Cooling System
0 . 2.Does the buyer have a homestead to be vacated 0 El S.Wind Power Device
for this residence?If yes,provide address: 0 E] S.Hydroelectric Power Device
Address(number and street) 0 C:1 7.Geothermal Energy Heating or Cooling Device
CRY,slate,ZIP code,and county dC-04