Homestead_Leek H. PREPARER
Prepar r o ZEi es D Ia5 rr Fo sc_plic1
,-.,1,1 oici(r.gic.c .,
Company E-mail address
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,Evansville,IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document
Nicholas Bengert Seller 2-Name as appears on conveyance document
dress number and street)
1
Q , Pry iC ` Or Address(number and street)
ode
City,
1-u d l "T r 1763
G City,state,and ZIP Code
Country Country
United States of America United States of America
E-mail address
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 Level 5 felony.
4ig re of Seller Signature of Seller
Printed Name of Seiler Date sig end(mm//dd/yyyy) Printed Name of Seller Date •ed Jyyyy)
Nicholas Bengert J 1/1w�,) i 1�
J. SUYER S/GRANTEE S -APPLICATIO�FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as appears on conveyanr•JANinei ZU21
Curtis J.Leek Amanda O.Leek
Address(number and street) Address(number and street) r ,, .,1, t;y i
521 W SR 68 521 W SR 68
Gt
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt,IN 47639 Haubstadt, IN 47639
Country
NO CONDITION
0 1.Will this property be the buyer's primary residence? 0 3.Homestead
0 4.Solar Energy Heating or Cooling System
co
N Er 2.Does the buyer have a homestead to be vacated for 0 5.Wind Power Device
ai ❑ this residence?If yes,provide address: ❑ 6.Hydroelectric Power Device '
f• Address(number and 1treat) I CI7.Geothermal Energy Heating or Cooling Device
0 v7�u
p City,state,and ZIP Code�fi• F0fIC 1 C County 26-18-36-404-000.323-009
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