Homestead_Quillen INDIANA SALES DISCLOSURE FORM SDF ID: Pagel
D.PREPARER
Sherri Hudson
Preparer of the Saks Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company,LLC
Address(Number and Street) Company
Evansville,IN 47708 (
E-mail
E.SELLER(S)/GRANTOR(S)
Terry D.Leek Donna K.Leek
S1;J3gr I-Na as appn c nveya ce docKrpen Sul -Name as appears on nveyance doe merit
A1•d/tdJrcl/r'bN/ombcr l/J)) �b/ 4-77 Ad ess umber and Street
andcomplete as required b�y�l/aw�,and is prepared in accordance with IC 6-1.1-5.5,"Real Prop Sal
)•closu a Act".
dr,
Sig.natureof'Sell Y /iTr' of .cr Y
Terry D.Leek 12/06/2019 Donna K.Leek 12/06/2019
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
.BUYER(S)/GRANT (S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Brandon T.Quillen
appears on conveyance document Buyer 2-Name as appears on conveyance document
665 SE Rancho Ln.
Address(Number and Street) Address(Number and Street)
USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPS .IDE TIFY ALL OF THOSE THAT APPLY. \ ,/)J1�k-- ��'
Y NO CONDITION YES NO CONDITION ��iiAA
0 1.Will this property be the buyer's primary 0 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary eating/Cooling System
residence,including county:
❑ ❑X 5.Wind Power Device
❑ E1 6.Hydroelectric Power Device
Address(Number and Street)
❑ � 7.Geothermal Energy Heating/Cooling Device
El 8.Is this proRerty a residential rental property?
City,State ZIP Code County
❑ El 9.Would you like to receive tax statements for this
0 [i 2.Does the buyer have a homestead in Indiana to be property via e-mail? (Provide contact information
vacated for this residence? If yes,provide below.Please see instructions for more information.
complete address of residence being vacated, Not available in all-caunti
including county:
Address(Number and Street) 26-12-06-401-001. 482-028
City.State ZIP Codt County maryprepenyownercon _ all
License/ID/Other Number JI