HomeMy WebLinkAboutHomestead_Edringtoni
INDIA\A SALES DISCLOSGRE FOR�1 SDF fD 26-2009-1000337 � Page.t
D.�PRENARER _�--'-�* � °- _'..::,- �r � _ _ _._ . . _. . _ . _ . .. ...
�.�{ . . - ..�.�.
SAMANTHA CUTSINGER BROADWAY TITLE, INC.
IPreporer JiEeSaleWsclomrrPocm P:le
226 W. BROADWAY BROADWAY TITLE, INC.
.lddre{: (-VVmbrl::nd Srnei) Compam�
PRWCETON, IY 47670 (
E-mail
CHASELANKfORD
Seller-,\'vme u opyeorz on �ar.��z��or.rr documrm Se/ler - t'umr nr nppean on rom�eroxr Am�mem
R.R. 1, BOX 187
.lddrev (.FUm.bcr crsd Streetl .4✓Q.ess I�'vmber lurd Sireeq
PATOKA, IN 47666
E-mnil Tr(zphaneh`umhn E-maif
Jnder penalties of perjur�-, 1 herebc certifr that this Soles Disclusure. to the best o(mc kno�rledge and belief, is true, correct and
on�lete as required bc la�c, � d is prepared in accordanee �ritli IC 6-1.1-55, "Real Properh� Sales Disclosure Act".
JEREMY EDRINGTON
OAKLAND CITY, IN 47660
�
£anail
�HE SALPS DISCIASURE FOltdl ?4U' RE USEU'PO.\PPI,I' F'OR CF;R
r 1. Nill this property be �he birvers primary residznce? Proeide c lere
address of priman� residrncc. including counN:
429 E. OHIO
A:iflress jNUmber��nAS�'mN/
PRINCETON, IN 47670 Gibson
circ. Sam. an✓7JP c�de counry
(- _'. Dozs the buyer ha��e a homestead to be vacaird for [his residence? lf
yes, provide complete address of residence vacatine. including county:
Ci?v, Sm�e, cnALPCwie Coumry
SrenammotSe/re.
P+inrMh'rsme oJTsl/er Sign Dote (.NAU�D.•Yn])
�r�ND CRI:DI"FS -
Rinrr -T'rm�e u. npp:an on comryonre Ax�mem
ArAhca (Numbrr and.Lrea/
Qnt Srare. and ]!P Code
PLY-
Telephone Numher Email
6DUCPIO�SPOR'1 PROPER"fV.IDE\TIPYALI.OF'I'HOSE'I'l1AT
r. 3. I-Iomestead
. o ar nerg}• Heating/Cooling System
� 5. N'ind Power Davice
r 6. Hydroelecvic Power Device
r 7. Geo[hennal Enerey Hea[ing/Cooling Device
r 3. Is [his propem� n residcntial rental propem�?
r 9. R'ould you like to recitve taz statements fur this property via
e-mail'? (Provide rortmcr infornmlion be/ow. Please ser Ihe
insmirtinns for rrtore injarmotion. i\'o� mni(able in o!1 ronntits.)
nes o� per)ury, � nereo�� rertu�� mac m�s �a�es u�saosure, m me oese ui mc enowiea�e anu oeue�, a �rue, correc[ anu comp�e�e as
law�, and is prepared in accordance �cith IC 6-1.1-5.5, "RCaI Property Sales Disclosure AcY'. (\ote: Spouu Information. Social Securiq•
�� License/other nurt�iers are not necessary if no Ilomestead Deduction is bein� Ned.)
5��
,v�,� ore„ti�
sy� nm.
STATE F00.N Si569 (IUB-10) TRFASUREA F00.\I TS-IA
APPROI'FD BY S(A7E BOARD OF ACCOU�TS, i009 PRESCRI9FD BY THE DEPMi��\T OF LOCAL CA\'FA.�'1¢\T FTA\CEiC4I.l-_'_'-8�
�• 1 / , � / / ' 1 � , 1 � , � .. `1!.._�
• yi. i w
::0 y..:
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
��Pduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•causes higher tas bills for all; therefore, HEA 1344-2009 requires taxpayers who recei��e the homestead
standard deduction to verify that they are eligible to recei��e the benefit and to provide additional identifying
inTormation necessary to allow county government to better monitor homestead filings. This information
�rill be kept confidential and can only be accessed b}' authorized county officials. The Department of Local
Go��ernment Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
Tainarer Xame
Jeremy Edrineton
Coiuplete and return to:
o� i
�✓Pm
�/
Las�
Each undersigned certifies, under penalty of perjury, that the above and foregoin9 information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also undersiands Ihat, by claiming additional homestead deductlons unlawfully, he or
she may be liable for back taxes and subslantial financial penalties.
0
� �� �_ �.Z '
�
' �