Homestead_Martin (24) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D.Tracey 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
Brent A.Conrey Kathleen M. Conrey
Address(number and street) Address(number and street)
2564E 1025 S 2-6(d L+ 6. 102 S Si
City, State and ZIP Code City, State and ZIP Code G�
Haubstadt, IN 47639 , IN 1- '1�}
1111iS / 10 LI 1 U t
Country Country
United States of America United States of America
Email Address
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.
Sigma ure of Selleer, Sig of e r t 4
ed Name of Seller44?- Date Signed (mm/dd/ Printe Name of Seller I Da4Signed(mmlddlyyyy)
Brerbt A. Conrey YYYY) Kathleen M. Conrey
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 a e conveyance document
Linda A. Martin
Address(ryn�umj er and strece�t) �,� ��— Address(number and stree
4 6:b
City,State n P tde V c City, State and ZIP CoIEC
Country Country
d
EmaeAddress States of
ddresof America
^ 4UOI
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:
YES NO CONDITION YES/NO CONDITION
ell)Aft
e/ ❑ 1. Will this property be the buyer's primary residence? 0" 0 3. Homestead
0 2. Does the buyer have a homestead to be vacated for ❑ (�4. Solar Energy Heating or Cooling :
this residence? If yes, provide address: 0 . Wind Power Device
%= 0 Hydroelectric Power Device
ddress(number and street) .`•
A, c ..q o S . 14)\\`ti ❑ 7. Geothermal Energy Heating or Cooling Device
City,Sta e, and ZIP Code County ('vim
-f- OtAc �, i .i�a 4 _`1 k c-1 0 2-6--21-oG-Z4o -Q�fl � ��- UDC( ,
... Under penaltie f perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete
as required b 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.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number_� is necessary if a Homestead Deduction is being filed.)
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