HomeMy WebLinkAboutHomestead_GrayINDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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:E.'SELLER(S) "GRANTOR (S)`._-,
Seller I - Name as appears on c document
Seller 1- Name as appears on conveyance document
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Address (Number and Sweet)
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Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
SignottirenfSeller Signature of Seller
Printed NO Seller Sion Date otM1Dp1ffM Printed Name QWdffr Sian Date MM/DDly"yyy)
F. BUYi5R(SJ/ GRANTEES ) " APPLICATIOWFOVROPERTY.-TAX DEDUCTIOPS---IDENTIFY, ALL: ITEMS
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THE SALES DISCLOSURE FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS
PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
YES NO CONDITION
❑ 1. Will this property be the buyer's primary
❑ 3. Homestead
residence? Provide complete address of primary
4. Solar Energy Heating/Cooling System
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2)
❑ Wind Power Device
WHydroelectric
c.)
❑ 6� Power Device
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7. Geothermal Energy Heating/Cooling Device
❑ 8• Is this property a residential rental property?
City S ZIP Code County
❑ � 2. Does the buyer have a homestead in Indiana to be
1:1 9. Would you like to receive tax statements for this
vacated for this residence? lf yes, provide
property via e-mail? (Provide contact information
complete address of residence being vacated,
below. Please see instructions for more information.
including county:
Not available in all counties)
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Address (Number and Sweet)
City, State VP Code County
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I Primary property owner contact name E-mail
STAY FORM 53564(53/SAO MEASLIER POEM TS-IA
APPROSTE BY STATE BOARD Or ACCOUNTS.MA FRFSCRIBFD BY THE DEPARTMENT OF LOCAL GOVERNMENT FP'AN(£IC 6_1.1.12-a.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 becomes
I Princeton. IN 47670 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 verify that they are eligible to receive the
FILED benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
° _ MAY 9 2011 Taxpayer Name Location Address
C V Lashbrook, Daniel L
204 MAIN •
GIBSON COUNTY AUDITOR c ___WINSLOW-INN 47598 '
4559 -- —
Greg DGray 1111111111.111111111111111I 1111III11111110111111111 II_II111I1111IVIBII11IiII]119I_ III
204 Main
' FRANCISCO IN 47649
- o State Parcel Number / Legal Description
26-13-19-202-000.142-005/ OLD PLAN 38PT
5
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.
\• __.P..d4i1 L2LIANPAYk:R.INFOlti�lt�l'JQN�
Owe. I First . Middle Last
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Mailing Address(number and street,city,state,and ZIP code) e as property address
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Spouse fist Mi.• e"1"11111.111%,,,,........... - Last
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.ling A....s(Number and street,city,state,and ZIP code) 0 Same as property address
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PART 3: CERTIFICATION -.
Each undersign=. -- - der •-natty of perjury,that the above .... - . In oration 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.
PART 4: ADDITIONAL INFORMATION