Homestead_Escobedo:
, - r ��': - _- , - ' -..
Preparer of the Salu Distbsure Form
Address (A'umber and StrmlJ
Evansville, In 47775
Ciry.Smlt andZlPCode
_. . :'�::lr_:--:L:,.;. � -. ...
Harrod Developtppnt LLC
Seller 1- Name as appears am m�veyance docvmen[
Addr¢s(NumberanCStree[)
Fort 8ranch. IN 47('i4A
[�
. . . . . ..- _ . . � ..`_�.. �°-- . -. ..
Reaional Manaqer
litle
� Paee 2
Direct Title Insurance Aaencv Inc
[ompany
E-mail
Seller 2� Name as appears on ronveyvnm documrn[
Addrw (h'um6er and Sveet)
City. Sm[e, and ZIP Lade
Under penalties of perjury, 1 hereby certify [ha[ this Sales Disdosure, to [he bes[ of my knowledge and belief, is [rue, correc[
and [omplete as requi�ed"Dy law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signa[ureof eller
Pon e o(Seller
� YER S GRANTE
3usana Escobedo
Buyv 1� A'ame as apyevrs on
i25VJ $VBf
Addrrss (A'umber and SveeQ
'rinceton.IN 47670
TNE SALFS DISCLOSURE FORM MAY BE USEU TO APPLY FOR CERTAI.Y DEOUCf10YS FOR
VES NO C09UITIOY
�✓ � 1. 4Vi11 this property be the buyer's primary
residence? Provide complete address of primarj`
residence, including county:
711 F Monroe Street
Addrus (Num6er and Svret)
Princeton IN 47670 Gibson
Ciry, Smce ZIP Code Counry
� ✓� 2. Does Ihe buyer have a homescead in Indiana to be
vaca[ed for this residence? If yes, provide
complete address of residence being vacated,
including county:
Addras (h'umber and Stree[J
Ciry, Smie ZIP Code tbup ry
Signamre o(Seller
ALL
Buyer 2- h'ame as appears om m�vryanre docvmen[
Addras(Num6erandSVeeQ
Ciry, Smre, and ZIP Code
IDENTIFY ALL OF
�✓ � 3. Homestead
� Q 4. Solar Energy HeaU ooling System
. m owerDevice
� Q✓ 6. Hydroelec[ric Power Device
❑ ❑✓ 7. Geo[hermal Energy Heating/Cooling Device
� Q✓ 8. Is this property a residential rental property?
❑ ❑✓ 9. Would you like [o receive tax s[atements for this
proper[y via e-mail? (Provide contact in/'ormanon
bel ee�ns uc oreinformation.
/ Not availa6le in alI counties.) \
� ia-a�-tiU3. oo i v 5a-oa
Under penal[ies of perjury, 1 hereby cer[ify [hat [his Sales Disdosure, [o [he best of my knowledge and belief, is true, torret[
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduc[ion is
being filed.)
��c,g�n,� �ix��'.2'cLc�
5(qnaNre o(BVyerl Signa[ure ofBUyer2/Spovse
sojSocial5ecuntyNum6er
Pnn[ed Legol Name o(Bvyer 2/Spause
Date (HM/OD/YYYI]
LastSdigitrojBuyer2/SpouseDmer's Smte LastSDigiuoj5ocio15ecurity
Num6er License/ID/OtherNum6er ,
STATE PoItM SJ569 (RV9-10)
APPROYED BY STATE BONtD OF.ICCOU\TS, ?009
IRFJSURER FORM TS-IA
PRFSCRIBED BY THE DEPART\�.\T OF LOGLL GO�'FR�NEYf FrvT.\CE IC61.1-_'_'-8.1
�o� A e � � ,.�, � � .
Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beueficial, there is more incentive than ever for homestead fraud. Homestead fraud
�uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpal'ers «•ho receive the homestead
dard deduction to verif�� that they are eligible to recei��e the benefit and to provide additional ideutifying
information necessar�� to allow county go��ernment to better monitor homestead filings. This information
��•ill be kept confidential and can only be accessed bv authorized county officials. The Department of Local
Go��ernment Finance �r�ill use this iuformation to create tools that rvill help counh� ofGcials eliminate �
Taxnarer \ame
Susana Escobedo
Camplete and return m:
�'�usan�
So�dal SeariH Nunter (las—t 5
J► /
A4tlEle
otnc Ipease w�A' in Pan a eno«)
Same as propciy aGEress
ss. � rnna Ipease sceab ��n a oeiw.)
Each und_rsigned ce �'fies, under penalty of perjury, that the above and foregoing infortnation is We antl covect antl that he or she is eligible to receive i
homestead standard deductlon on this property. Each undersigned also undersfands that, by daiming addiGOnal homestead deduclions unlawfully, he w
she may be liable for back taues and subsfanUal finandal penaltles.
oxnc t S<pariue
��
ia-3 �-��
TNephme
Ttlep�me
DEC 31 2012
c.
GIBSON COUNTY
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