Homestead_Brinkman H. PREPARER
i Preparer of the Sales Disclosure Form Title
' Kris Coon Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I.SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Greg D.Gray T• risha A. Gray
dr4.s V/bercst Q �_ Address(number and street)
II I
it ,. Z f deN 4) 41 tg2t9 . City,state,and ZIP Code
Country Country
USA _ USA �
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 s felony.
Signature of Seller Signature of Seller e-•--.
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name oo Seller = '�.ned m ddl
Greg D. Gray Fs '-y.-zo��Trisha A. Gray ; ^ ...
'(�t�,s
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-I TIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appea ce document
Kerri Brinkman
re ( um rile net)d et) Address(number and street)
ED
vrtstamm ,sw 4q"J V�K^49 City,state,and ZIP Code AUG 0 6
Country 11 Country ,025
USA USA
apply for certain deductions.Identify all' at apply:
YES NO CONDITION Y.,S/NO CONDITION
VO 1.Will this property be the buyers primary tad' 0 3.Homestead
residence? 0 ter le-
� 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 Nl 5.Wind Power Device
O for this residence?If yes,provide address: O 1d�/
6.Hydroelectric Power Device
Addl s� (� ra a�� ivi�tfti� ('; 0 7.Geothermal Energy Heating or Cooling Device
,I 1 lOd u" �S�i� CLJCo. 2-G -1S^ 19 —2)2— coo. 11.1 z.-o's�
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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