Homestead_Gray (4) •
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Preparer of the Sales DisdForm Ti
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Sherri Hudson Settlement Agent
Company Email Address
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansvale,1N 47715
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Seiler 1—Name es it appears on conveyance document Seller 2—Name as appears on •
Joan Gray r
Address(nuniber and street) Address(number and street)OCl
2079 S 1200 E "2 ,
City,State.and ZIP Code City.State,and A• >••- 'Q13 /i
Oakland City,IN 47660 461i, - (----- )
County Country CO 11
US �N�,
cat 00.604dga�ii00afrei-litr�ie,
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a_Teal.ptioperty or anhsarlalaifiesar [ir onuequirtii.iX abe.`{roirided col ariit a;Lev�et5Stitty --- ==�,..:;-
Signature of Seller P2.A.A.C.
Signature of Sellery ': :: :: :04"litiq Lj7 i a 4�F
Vnted Name of Setter H'h-i - Date Signed(nvn/ddiyyyy) Printed Name of Seller Date Signed(mmldd/yyyy)
Joan Gray 1�rzrSe�_trerv.ne�l
:00.0.40:iG ts1 APPLICATION RtOERT.-T.;e 1 `o s ro i ; _ --:
Buyer 1—Name as I appears on conveyance document Buyer 2—Nameas it appears on conveyance document
Brian J.Gray
Address(number and street) Address(number and street)
530 N.Clay St.
City,State,and ZIP Code City,State,and ZIP Code
Oakland City,IN 47660
- Country - Country
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��plyfw':-certairfy�ctioits.lcferttifya9.a#these-thatappFjl ::-.;;4..`-;�:
: YES NO CONDITION Y NO CONDITION
. ?L ❑ 1.Will this property be the buyer's primary 0 3-Homestead
4�` residence? 0 EX 4.Solar Energy Heating or Cooling System
1,.K 2.Does the buyer have a homestead to be vacated 0 ( 5.Wind Power Device
0 for this residence?If yes,provide address: • 0 ® 6:Hydroelectric Power Device
Address(rnmrberand street) 0 rb 7.Geothermal Energy Heating or Cooling Device
City,State;and ZIP Code CrAinlY
2G-- IL)—11-300—(0O(0 .Zb1- —u66
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