Homestead_RennerINDIANA SA ES ISCLOSURE FORM SDF ID: Page 2
D. PREPARE _
Dan L. Reeves
Preparer of the Sales Disclosure Form
116 S. Main Street
an (Number and Street)
ceton.IN 47670
City, State, and ZIP Code
Email
E. SELLER(S)/GRANTOR(S)
FHa MA, Steward-
S. Wind Power Device
Seller I Nome as appears on conveyance document
607 Chestnut S1rPP1
Seller 2 - Name as appears on conveyance document
Address (Number and Street)
Francisco IN 47644
Address (Number and Street)
City, State. and ZIP Code
E -mail
Telephone Number E -mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and ckmplete as re tied by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
LN QN I i
yr = L Signature of Seller
Printed Name o Seller S nDate M DD Pn'n[ed Name o Seller Sian Date LMMIDDIYYM
R S GRA IqT§E S -- APPLICATION FOR PROPERTY TAX DEDUCTIONS -' IDENTIFY ALL ITEMS,THAT APPLY -.
Kerrie Renner
9. Would you like to receive tax statements for this
Buyer I - Name ears an conveyance document
3 Ie Dt KK
Buyer 2- Name as appears on conveyance document
Address (Number and Street)
P nceton IN 47670
Address (Number and Street)
— 'm¢. and ZIP Code
E -mail
Telephone Number Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TH
Y. IDENTI F THOSE THAT APPLY.
YES NO CONDITION
Q 1. Will this property be the buyer's primary
residence? Provide complete address of f
residence, including county:
Address (Number and Street)
City, State ZIP Code County
0✓ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (Number and Street)
Ciry,
County
❑ ❑ 3.
Heating /Cooling System
❑
U
S. Wind Power Device
❑
[Z]
6. Hydroelectric Power Device
Q✓
7. Geothermal Energy Heating /Cooling Device
Q
8. Is this property a residential rental property?
F1
❑✓
9. Would you like to receive tax statements for this
property via e-mail? (Provide contact information
below. Please see instructions for more information.
Not available in all counties.)
aaa -6o0 , aG C9 -640'. 5
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 ". (Note:
Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
being filedl\ o_ ... n i
Printed Legal Name of Buyer I
(.
Last 5 digits of Buyer 1 Driver's
License /ID /Other Number
Signature of guyer2 /Spouse
Printed Legal Name of Buyer 2 /Spouse Sign Dow(MM/DDIYYYY)
State Last 5 Digits of Social Security Number I Last 5 digits of Buyer 2 15pouse Driver's State Last 5 Digits of5ocial Security
Number License /ID10ther Number
STATE FORM 5J549(R3/8I0) TREASURER mast TS-IA •
APPROVED BY STATE BOARD OF ACCOUNTS,YW PRESCRIBE")BY TIE DEPARTMENT OF LOCAL OO VERNMtNT FINANCE IC 61.1-12-0.1
Gibson County Auditor 1M'MPOR1ANT NOTICE TO HOMESTEAD PROPERTY OWNERS
1 0;N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
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
` 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
Taxpayer Name , Location Address
Stewart, Etta Mae
607 CHESTNUT ST
.. FRANCISCO IN 47649
-4584 •
Kerrie Renner I II II
IhiII III �III��i �II flIIIIII�II�IIIOI �II_II II�III1I.1111 11111111,1111/ II
PO Box 91
607 Chestnut St
FRANCISCO IN 47649-0091
III'i1ll1l'1111"I"ICI'II'IllIllllllllItrlllI'lllrlrllttlllllIll State Parcel Number / Legal Description
26-13492202-000.262-005 /F 8 MC 15/16
FILED VVV
APR 5 2011
This form MUST be1B tu1EM� ioRlnty Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PAR112:TFAXPAYER.Ii\FQR:�LATION __-_ - _
First Middle ____. -_-_-_—._—____. Last__
eal6 Lei N - �ErJ E2
Mailing Address(number and street,city,state,and ZIP code) �ame as property address
P� - 6.x qI (ion Cl-ESrNu -rSr FAA-KI ISC
Spouse _ /First -Middle - Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
I I - I I 1 . - I I I 1 Stir
PART 3: CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information 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 Sign [ . Date
PART 4: ADDITIONAL INFORMATION