Homestead_Kenworthy H. PREPARER
Preparer of the Sales Disclosuree�Foj /J� / Title
"L_. ''.1.,..L._ Title Company
Company
Address(number and street.city.state.country,and ZIP Code)
7820 Eagle Crest Blvd.Suite 201,Evansville,IN 47715 �\
I. SELLERS)/GRANTOR(S) �'
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance nt
BrianK.Hurt NQ`
Address(number and street) Address(number and street) t3/ �92�Z -6
602 S Mohican Drive
City.slate.and ZIP Code City.state,and ZIP Code 6..0
Patoka,IN 47666 _ -C Q
Country Country 2.)-
US A4.,Ci7. i
the best 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 Levet 5 felony.
Si a of Sell-r� Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmfdd/yyyy)
Brian K.Hurt 11/18/2022 11/18/2022
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
Rebecca J.Kenworthy
Address(number and street) Address(number and street)
115 N Brown Street
L� City.state,and ZIP Code City,slate,and ZIP Code
Princeton,IN 47670
C,-Country
1 ----- Country
c-') US
-�d�i
( )
Pursuant to IC 6-1.1-12-44,the Safes Disclosure Form may be used to apply for certain deductions.Identify all of those that apply -
YES NO CONDITION YES NO CONDITION
0 1.Will this property be the buyer's primary 0 3. Homestead
1 residence? 0 Q 4.Solar Energy Heating or Cooling System
0 2.Does the buyer have a homestead to be vacated 0 5.Wind Power Device
for this residence? Ii yes. provide address: 0 a 6. Hydroelectric Power Device
Address_(numterer and street)--�- 0 g 7.Geothermal Energy Heating or Cooling Device
•
1 state.ZIP C de,and counyc.
—_ r , - 0r, r�1 `�—iVl D 26 -off-ZS- tocoo-ono G o' -oz0 .
k. Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
n 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
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5 C 0