Homestead_DickeyI\GIA\A S.hLES UISCLOSGRE FOR�I SDF IU SDO ID 718366 I'age'_
D.PREPARER
Jay D Walden Atmmey at Law
henarero%tlre Snlcs Uisdamre Fann iiGe
� North Street Jay D. Walden, Attorney at Law
.. as/�VUm6ernnd5'veel% Cnm�am•
Grayville, IL 62844-
E. SELLER S GRr1NTOR S
J. Mark Rawlinson
Seller i- Nome as appenrs on ronvryanre dncumenr Seller? - Abme nv iqopeors nn canre�vnce donunmt
�832 Orchard Road
Addrcss (Number and S:reet� Addross (f:wnber nnAS[reeC)
Evansville, IN 47720.
CiN. Sm:e. nnd ZlF Cade Ciry. Sm[C ��nA%IP CoRe
f-mail Tele�hnnekurnber F.�nroil
Under penalties of perjury, 1 hereby certify [ha[ Ihis Sales Disclosure, [o the bes[ of m}' knowledge ancl belief, is true, con�ec[
a d comp ete as qi e by la� �, nd is prepared in accordance �vi[h IC G-1.1-S.S, "Real Property Sales Disclosure Act".
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` F ERS GRA�'TE —APPLICATIONFORPROPERTYTAXDED — ' FYALLITEP7STHATAPPLY
1 James L. Dickey � Beth E. Dickey
nvrr]-:�ameas ^ ..onronve�nnredwumen: uver?-ROmrntn ^ ,ontom�n'nnteduturnent
272 E. n 212 E. 2n r t
.4ddress(Numberond5rreel) Addrus(,YUmberandSlreetJ
M, �armel, IL 62863- Mt. Cartnel, IN 62863-
�le, anE %IPCnAe Cip�. Smce. nnd ZIP CMe
umber E�mai/
THE SALES DISCLOSORE FORM PIAI' BE USED TO APPL\" FOR CERTAIA DEDI1CfI0N5 FON THIS PROPERTY. IOENTIFV ALL OF THOSE TIIAT APPLI'.
1'ES \0 C05DITION I 1'ES KO CONDITION
�X � 1. lVill [his property be the bu}•er's primary Q � 3. Homestead
residence? Provide complete address of primary � � 4. Solar Lnergy Heating/Coolina Sysrem
residence, inciuding county: ,.
1807 EAST BROADWAY ❑ Q 5. N md Power Devicc
eddrrss�Numbei und5uee[J ❑ Q 6. HydroelecVic Power De��ice
Prince;on, IN a7670 GIBSON � � �. Geo[hermal Energy Heating/Cooling Device
Ory, Smre ZIP Code Caunq�
�� 2. Does the buyer have a homestead in Indiana to be � 0$� Is this property a residencial rental property?
��acated for diis residence? If yes, provide ❑ Q 9. 4l�ould you like m receive tax statements (or this
complete address of residence beino vacated, property via e-mail? (Provide cmxoct in%rmation
including county: below. Please see instructions/or more in%rmation.
�`at uvailahle in all coun[ies.)
Address (Numbrr anAStree:)
Ciq; S:n�=ZIPCaIe Counry• �/� �� / oD� •��O _ D��
Pn'maryproperry�o�vnerronmctnanre E'��rtoil
Under penalties of perjury, 1 hereby cer[ify tha[ this Sales Disclosure, to [he bes[ of m}' knowledge and belief, is true, correc[
and complete as required by law, and is prepamd in accordance with IC 6-1.1-SS, "Real Property Sales Disclosure Ac[". (No[e:
Spouse informa[ion, Social Security and Driver's License/Othcr numbers are no[ necessary i( no Homes[ead Deduction is
being filed.)
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��ii�rer� C 7>ici�� �� -io -1/ Signar . ���.�h,�=e � , ck�i �-�o-l/
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LastidigittofBurerlD�i•rer's Smre LostSD(gicro�Social5ecu�iNNum6er LastSdigin�o�Bu�•er2/SpouseDriver's Smte LostSDigitsojSocinlSrruriry
License/!D/OtherNum6er Number Ucense/ID/OtherNum6er
sT,.� Foa.� s�sas �aio�
TRFASURER FORM TS-IA
MPRO\'ED BY STATE BOARD OF ACCOU\T5. 2009 PRESCRIHED BY i}iE DEPARTNEM OF LOCN. W\'EA.�I¢�T FTA.�C61[¢I.1-'_'-B.1
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Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to ��erify that they are eligible to receive the benefit and to provide additional identif��ing
information necessary to allow county government to better monitor homestead filings. This information
�vill be kept con5dential and can only be accessed b}' authorized county officials. The Department o( Local
Government Finauce will use this information to create tools that will help count}� officials eliminate
homestead fraud.
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Taxna.'er \ame pronem' Addrns $Iale Parttl \umber Leeal Descrintion:
J2mf5 L DICkC}' 1807 E BROADWAY ST 26-12-OS-401-003.670-028 PT NW SE 8-2-10 1.077 AC
PRt1JCETON M 47670
Comolete anJ return m: I��I��� f��ua➢��i���l�'��II��III�II,,II:I�I�I��
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
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Owner 1 , Firs� MiGCIe Las�
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Mailing AtlCress (riumpar en0 s:taet, ti�y, state eM ZIP cotla) ❑ Same as propetly eEtlress
!Sd 7�, $�v<mw�-y o,e itic�7aN ,� �� 6 0
Sodal Seaairy NumCx past 5 aigits) Orivefs licensel5tata ID NumDer past 5 dlgltq �• �� (deatt spetity in Part 4 pelvw)
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Spause Fust � MiOtlle Last
B�%� -�� 1�1����y
Nailvg PCCreu lruunbar arq YJeet. ti7. s�ate anE ZIP coEe) � mq as property aGNeu
Social Secvnry NiaMer (Iast 5 Elglb) �^ Ourer (please spedy in Part a �elow)
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Each un6ersignea certifies. under penalty of perjury, that the above and foregoing information is true and wrrect and that he or she is eligible to receive the
homestead standard dedudion on !his property. Each undersigned also understands that, by claimfng additional homestead deductions unlawFully, he or
she may be liable (or back tazes and substantial financial penalties.
Oxner 1 SpnaNra Oate Teleplione
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• NOV 15 2012
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GIBSON COUNTY AUDITOR
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