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Homestead_Higgins (2) H PREPARER Preparer of the Sales Disclosure Form Tim Settlement Agent _, ,.-. E-mail address Bosse Title Company_ - Address(number and street call,state,country,and ZIP Code) 4799 Rosebud Lane,Newburgh,IN 47630 -•- I.SELLER(S)JGRANTOR(S) Seller 1-Name as it appears on conveyance document Seiler 2-Name as appears on conveyance document Peggy L.Hensley ..p_ Address(number and street) Address(number and street) ...r.t. 106 E.Walnut St. -__ _ _ .,,. -. City.state.and ZIP Code City.state,and ZIP Code c Owensville,IN 47665 D`C 2 • Country Contry I ZQ1Z �` US n E-mail address ' to the best of my knowledge and belief,is trustAb 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 value of transferred real property,or omits or falsifies any information required to be provided.commits a Level 5 felony. Signature of Seller Signature of Seller /.1 `'a. r`' �r�` b ..g.1) .'e."f;.'-IL, `a '.v1 i2((1'-11,77Z mm/dd/yyyy) , Printed Name of Seller 1 Date signed fmmidd/yyyy) Printed Name of Seger Date signed Peggy L.Hensley tC ens4i. 1104. to P - ••-_ I 12/20/2022 J. BUYER(S)/G NTEE(S)-APPLIciATION FOR PROPERTY _ _ E NO CONDITION X 1.Will this property be the buyer's primaryO 3.Homestead 0 residence'? 0 al 4.Solar Energy Heating or Cooling System 2.Does the buyer have a homestead to be vacated , O Gil 5.Wind Power Device X0 for this residence?If yes,provide address: 0 ill6.Hydroelectric Power Device Inn 7.Geothermal Energy Heating or Cooling Device 10322sGm Stand street) O City.state.ZIP code,and county Cynthiana. IN 47612 ' l 7-1 Z �! ,K_ O O Ll 3 r'. _ C Under penaltbes of perjury,I hereby certify that this Sales Disclosure,to a best of my knowledge and belief,is true,correct and corn plate 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 Page 3_ copy ,- .