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�INDIANA SALES DISCLOSURE FORD7 SDF ID: � Page 2
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�;D�PREPARER'�,F..r�zt..at� :vfki�g �,> :: ;`* it:3�:.=� ,-�.:.-_£+�F s 3`z,�t`1�;ia:' ra�.i,��a�•..st"`Y''=�..%.-Y't��� �.{i,ei�:b, •a �-'-_.ts.,x-+i:l;'_��.us's�
Jenny Armes Customer Service Rep.
� Preparcra(lheSalaDUdoturcForm TLe
�525 E. 82nd St., Suite 110 Statewide Title Company, Inc.
Addr¢s(Num6erand50-eetJ �
Ciry, Smh, and Z/P Cod^ Telephone A'umber Emoil
iE.`SEL"liEIL S �GRf1I��TOR:$ �ss'�%i:`��.}r .�`h�"�'�i�'"S`3:�•':�'-iv; t�"'�i��`?'�3?0."*.'^�c'�L`�i'-C+i'::��' .�.1'�.;����T`si ..��i4}S.t=k'z^siGS`��-},�`:°:'.i
Federal Home Loan Mortgage Corporation
Selier ]� Name as appmrs om m�veyanre docvmmt Seller 2- Nome as appears on ronvryanre doaumrn[
5000 Plano Parkway
Addras (Nvm6er and Strm:) Address (h'umber ond Strce[)
Canolltoq TX 75010
Ciry.Smte, andZlPCode Ciry�.Smh, andZlPCode
E-mail Tele�honeNumber E-mail
Under penalties of perjur}', 1 hereby cer[ify [ha[ this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co et s required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Aeal Property Sales Disclosure Act".
Sqna re f5elfe� S(qna[ureo($eller
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Buyer7 � Name as appmrs on convryance docvment Buyer? � Name as appmrs on ronveyontt docvment
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Address (Number and Stree: Address (A'umber and Sveet)
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�Ciry.Sw[e. andZlPCade Ciry.Smte, onEZIPCode
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f-mail Tele�honeNumber E-mvil
THE SALFS DISCLOSURE FOINf M.IY BE USED TO APPLI' FOR CERTAII DEDURIONS FOR THIS PROPERTI'. IDE\TIFI".1LL OF TNOSE THAT APPLI'.
YFS NO COSDITIOS I YFS NO COSDITIOf:
� 1. Will Chis properiy be ihe buyer's primary � 3. Homestead
residence? Provide mmplete address of primary � � 4. Solar Energy Heating/Cooling System
residence, including count}^ � Q 5. yit�nd Power Device
lIS Dl�oe Dr;re.
Addren(A'vmbrland5vee[) ❑ d 6. Hydroelectrit Power Device
�Rmee_�-c..� �R% y�G 7 D i> � I3 sG �✓ � Q 7. Geothermal Energy Heating/Cooling Device
Ciry.SrcteZ Code CaunN
Deductions.
❑ Z. Does the buyer have a homestead to be vacated for
this residence? [f yes, provide complete address of � � 8• �s this property a residential ren[al property?
residencevacatin„includingcount}�: �� 9o� �a 9• 9a� �a�
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Addrus (Number and Street)
Cin•, Srure Z!P Lode Caunn
Under penalties of perjury, I hereby certify tha[ [his Sales Disclosure, to the best of my knowledge and belie(, is true, corrett
and omp e as re uired b law, and is prepared in accordance with IC 6d.1-S.S, "Real Propert}• Sales Disdosure Act".
s� e•, �.�1 II � s(q�ai,..ee�e�y«z
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PrintedNameofBvrerl SionDa¢pIM/DO/YYYY� PrinredNamea Buver2 Si nDate(riu/DD
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$TAiE FOR.N S1569 (RJ/8-10) IAEASURER FORM TS-IA
APPRO\'FD BY STA1E BOARD OF ACCOU\T5, 2009 PRFSCRIBFD BY THE DEPMTfE\T OF LOCAL W VER.\'ME\T Fl\q.\CE iCbl.l .2-e.l
, / � / 1 / . ' 1 � , I � , � y
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this v
�a^duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2009 requires tazpayers �rho recei��e the homestead
standard deduction to verify that they are eligible to recei��e the benetit and to provide additional identifying
information necessary to allow count}� government to better monitor homestead filings. This information
�vill be kept coufidential and can only be accessed by authorized couoty officials. The Department of Local
Government Finance will use this information to create tools that will help count}� officials eliminate
homestead fraud. �
Zeinarer \ame
Efrain Gallegos
Comp(ete and relurn !o:
.� !il
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Pron<rb'Address
115 E OLIVE DR
PRINCETON IN 47670
Shte Parcel �\vmber
26-12-18-304-003.303-028
IO�II��IC��]00[
G[BSON COUNTY AUDITOR, 101 N MAIN PRINCET01 IN 376 i0
Fvst
� Otner (please soecity in Pen < oelow)
Each unaerslgnetl certffies, under penalty o( 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 this property. Each undersigned also understands that, by claiming additional homesiead deductions unlawfully, he or
she may be liable for back taxes and substantial financial penalties.
O»nm 1 Sim�aMe� Dale