Homestead_Moser l';et\\q s-s1.ES DISCI.ost:RE FORM SDP ID 38-2011-1673428 -Page 2
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•.ROSE?:BERG ATTORNEY
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' ,r .'IONS 44,•44
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i nit pi nailics of perjury. I hereby certify that this Sales Disclosure,to the hest of my knowled}te and belief, is true,correct and
cony..:.; • as required by law,and is prepared in accordance wills IC 6-1.1-5.5. "Real Property Sales Disclosure Act".
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, ,. Marren Burk II ;;mnn.r;,v"dl..si
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'F, R!�l FR(S;GRANTEE -..APPL A ION.FOR DEDUCTIONS:AND CREDITS-IDENTIFY ALL ITEMS THAT APPLY-
r :(.r.i:-:.v;MOSER SR I JANICE M MOSER .. ... 4 4 ..-
. . .,,.n.u.0.het, ..„ Surer-::mn.s a/gavmm,r,n.,rum,.ln,unnna
_ .,R.2'_v5 5820 E CR.2505
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=" •- :;-CO IN 47643 FRANCISCO,IN 47619
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'i_'_-_ r■ uL..Lest RE FORM NIAy BE USED.10,U'PLY FOR CERTAIN DEDQCITONS FOR THIS I'ROPERT A.IDEYTIFA,\I.1.(IF'FHOSE'I THAT
do-1-ol:e iv be the buyer's primary residence?Provide complete F ?. Homestead
:3,i,v.•of:Thru:r:r::widener.including county: r 4.Solar Energy Heating/Cooling System
54...0E _• 2505
r 5.Wind Power Device
'.- ,-. 3c' 47649 Gibson r ti. Hydroelectric Power Device
-- .. (nuns r ;.Geothermal Energy He:rtin&Cooling Device
. r _ t,.,.-ti.-:n..y:r I:s:e a homestead to be vacated for this residence?If r S. Is this property a residential rental propene'!
,.-d,com;iete address of residence vacati:w.including county:
r 9.\h'ottld von like to reties laa statements for the propeny vi::
c-mail?(fin ride Sohn t in/;:nnulion h:/on:Mona'At-the
invirurlinnc fn.name in,him,IM,,:.Nor onulu/dr in,dl counties,)
Prime,;-j.,o; -,n'on nCr contact norm G•mr:l
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iT.Ut FRM534 ,PV'tot IleASCRER 0/P_LISLA
.VMrnEEO p1 MEM tknOF.YC4R:Til•n MLYRfTDm"TR DV.U1MLT 01 LOt'.LLCa1S}AML%I IL\CcLIC NI42- I
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS,'
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction become,
Princeton. IN 47670 more beneficial.there is more incentive than e•er for hom;stead fraud.Homestead fraud causes higher tat bills fbr ell:therefore,
III:A 13-14-2000 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to receive the
FILEDand to orm'ide additional identifying iti iand en necessary to allow county government to better monitor homestead
JIpIL Blimps.This information will be kept confidential and can only be accessed by authorized county officials.The Depanmert of
4 Local Government Finance will use this information to crunte tools that will help county officials eliminate homestead fraud.
PART I:PROPERTY INFORMATION
SEP 2 6 2012 Taxpayer Name Location Address
Old National Bank
5820E 250 5 -
GIBSON COUNTY AUDITOR FRANCISCO IN 47649
4537
DONALD L MOSER Sr. I I I 1 1 1 1 0 1 1 1[III VIII I I IIIIIII�1 1„ II�III 011 UII I II II 0IIIIIiIii 11 1111
5820E 250 S
FRANCISCO IN 47649-9065
II�11�11�11��"1'I'�I��Illlll�tl�ll��'11'111"��I'I'lll�tl��l��lt State Parcel Number Legal Description
26-13-19-300-001.614-004 PT SE SW 19-2-9 2.226 AC
D-10
0
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer
' ;ttaavnis.ICLja
I First Middle Last —
2)0NA Zee iYIO5-6 ,se•
Mailing Address(number and street,city,state,and ZIP code) lEf Same as property address
SWtz6 • r2 SC! 5• t/I.4jvC'SCD y16zA4
Spouse First Middle Last
./ 4frifinde /Yi0 s
Mailing Address(Number and street.city,state.and ZIP code) Same as property address
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
.