HomeMy WebLinkAboutHomestead_Splittorff (2) 2012-11-07 07:25 gibson county dfr » 8123861173 P 3/3 .
STATE PORM SUM(R]I1-10 .
APTWV6)BY STATE ROMP OF ACCOUNTS,2009• PRESCRIBED BY ncs DEPARTMENT OP LOCAL GOVERNMENT FLNANCE IC6.11 X41
IMPORTANT NOTICE TO HOP ESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction.As the receipt of this
0 deduction becomes 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. .
' PARTI: PROPERTY INFORMATION .. -'
immix Nun - Frown',Addree - _ 5bte Paml Number 1e2a1212a indon:
]man K S Iittorff 101 COLLINS RD
D FRANCISCO IN 47649 2613-20.103-000.057-005 COLLINS ADD 10
•
Complete and tenant 10: . . 1®1i96ig enifilm®INMEMI ®EC®®.
GIBSON COUNTY AUDITOR,101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION
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Each undersigned certifies,under penalty of perjury,that the above and foregoing information S 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 name for back taxes and substantial financial penalties.
Oar(I Sipaea re Dab
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PART 4:ADDITIONAL INFORMATION _ , _
•
FILED
NOV 7 2012
c.3.rre
GIBSON COUNTY AUDITOR N
INDIANA SALES- D ISCLOSU RE FORM SDF ID: Page 2
Jj:PPEPARER,,
CHRISTOPHER E. CARL SETTLEMENT AGENT
Pre parer ofthe Sales Disclosure Form Title
20 MAIN STREET, SUITE 1307 EXPERT TITLE SERVICES
Iaddress (Number and Street) C.-P—Y
EVANSVILLE, INDIANA 47708 812-437-5700
ore, Scam and ZIP Code Telephonellaraber E -mail
E. SELLER
THE 8 I AH P BAILEY REVOCABLE TRUST
Seller I - Name as ay c,mveyancedotunen•
Seller 2- Name as appears on conveyance document
mi
IfOess Iftenber and S`rA,
Address (Number and Street)
:50
Email
Telephone Number E-mail
der penalties of rjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
p "�'rfu
complete I bylaw, at
c Orn _ e ayeq III is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Vire
r
� a of sel er
gnotvre OfSeller wre of Seller
I ISA F 5i o
PaperdlTameorseller Sian Date (MAIDDIr--- Printed Name o(Seller Sian Date (mmrDD1Yym
...'BUYERS ) IGRANTEE (S) - A P P L21 C!A: ON FO R PROPERTY TAX D E,D UCT 10 N S I I D E N T I FY A LL'ITEMS THAT AP PLY
BRIAN K. SPLITTORFF
Bayer l- Name as appears on can v ument
Buyer 2 -Name as appears on conveyance document
Address (Numberand Street)
Address (Number and Street)
FRANCISCO, INDIANA 47649
City, State and ZIP Code
E-mail
Telephone Number Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN 1)7015 _FOR THIS PROPERTY. IDENTIFY ALL OF SE THAT APPLY.
)I
YES 11; 0 CONDITION YES NO CONDITION
F,-/l ❑ 1. Will this property be the buyer's primary
3. Home t
residence? Provide complete address of primary
. a ar Energy Heating/Cooling System
residence, including county:
S. Wind Power Device
101 COLLINS ROAD
❑ 6. Hydroelectric Power Device
Address (Number and Street)
FRANCISCO. INDIANA 47649 GIBSON
❑ . Geothermal Energy Heating/Cooling Device
41
\K_1
lip; \.—. Code County
—ZIP
❑ NP 2. Does the buyer have a homestead in Indiana to be
8. Is this property a residential rental property? ❑
vacated for this residence? If yes, provide
❑ N 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not available in all counties.)
6 ,
^/3_0,00 -/a 9-
Address (Number and Street)
BRIAN K. SPI-ITTORFF
City, Sm te ZIP Code County
Primary property owner contact name E -mail
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:
S Ous information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
filed.)
led.)
-
Sign a m re of Buyer Tl Signature ofBETer2lSpouse
111111111 ORFF
'
Secunry Number Last 5 digits ofBuyer2l5pouse Driver's State Last 5 Digits of Social Secunry
LicenselID10ther Number I Number License /ID /Other Number