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HomeMy WebLinkAboutHomestead_Schmidt (2)V r( L C V INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 466680 Page 2 r D:PREPARER - Samantha Cutsinger Prepare, ofthe Sales Disclosure Form Title 226 W. Broadway Broadway Title, Inc. Address (Number and SUeea) Campany city, State, and ZIP Code Telephone Number E -mail E. SELLER(S)/GRANTOR(S) - - - - Carolyn Ellerbrook Sel1er1 Nomeasnppearsontctmt,vnsedaumrnt Seller2 -Name ns appmrson mnveyuncedavmenr 95323 E. Main St. Address (Number and Srrret) Address (Number and Strerr) Mackey, IN 47654- Cary, Suu4 and ZIP Code City, Since, and ZIP Cade Number E -mail Tele one 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 as requiredd by ,law, and is prepared in accordance with IC 6- 1.1 -5,5, "Real Property Sales Disclosure Act ". complete Signv re afseller I SlgnatarrofSeller ' k. 1 r fJ rook 1 -: -BUY -GRANJ-T.EES- APPLICATION FOR PROPERTY - iFY.ALLITEMS -THAT APPLY Jack P Schmidt Addie Schmidt Bayerl -Name ns appmrsnn cevancedotumm: Buyer Name assn n mnvtwncedacumen[ P.O. Box 107 P.O. Box 107 Address (Ni mbermed St eet) Addres (Number and Street) Mackey, IN 47654- Mackey, IN 47654 - 'Ciry.Staw.. add ZIP Code / Ciry, State, and ZJP Code %E -mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR 7n I DENr1FI' ALL OF TH OSE THAT APPLY. YES NO CONDITION I YES NO CONDITIO. x❑ ❑ 1. Will this property be the buyer's primary ❑x ❑ 3. Homestead residence? Provide complete address of primary__ 4. Sol eating /Cooling System residence, including county: ❑ 5. Wind Power Device 9532 E. MAIN ST. ❑ © 6. Hydroelectric Power Device Address (Number and Stmt) Mackey, IN 47654 GIBSON ❑ © 7_ Geothermal Energy Heating /Cooling Device ❑ © B. Is this property a residential rental property? City, State ZIP Code County ❑ ❑ 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide ❑ © 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.) �/ — e- (� 40 -/ 'Z-/O s !/ e) Q• L Addres (Number and Street) City. Smte ZIP Code Connry Irlma7praperry omer ronmRnam e E' all 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 filed.) r SignatureofDuyeil Signature ofBuyer2 /Spouse Oy�a;�° ,bp T Oy117A1e> ,4 Printed Legal Name of Buyer l Sign Date (MR/DD/Mn Printed Legal Name of Buyer 2 1Spouse Sig Date l../DD/1Ynl LostSdigits ofB yei— r1� State Lost S Digits of5ociol Security Number LostS digi10 Buyer 2 1Spouse Driver's fate Last 5 Digits of Social Security License /ID10ther Number Number License /ID /other Abmber i. anrt ITIRA}t901,10/411/1 TREA.IREE FORM IS-IA f APPROVED RI'WOE 9n\Ro OF,IF 101SI[3m rR N:WIPP m'TIY.OI�T.VEvIOF LIXALCOVFARW.RT FINANCEIC b!yrss I • Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS' 101 N. Main Street Individuals and married couples ale 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 hoincstcad fraud.Homestead fraud causes higher ins bills for all:therefore, iii IIFA 1 344-2009 requires taspavers who receive the homestead standard deduction to verify that they are eligible to recei\e the benefit and to proside additional identifying inlisrmation necessary to allmv county government to better monitor homestead FILED filinp.'I'his 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:hat will help county officials eliminate homestead fraud. —-- - - — MAY- 1 0-Z01Z-- • - .. PART I:PROPERTY INFORMATION.' . • . Taxpayer Name Location Addie'si - — - C. .tr Schmidt, Jack P/Addle 9532 MAIN ST GIBSON COUNTY AUDITOR ' MACKEY IN 47654 8647 Jack PSchmidt 11010111.0111010110011101011011111111 III 11101111 IH1101 II 1.1111011_III III II 9532 E Main St MACKEY IN 47654 State Parcel Number Legal Description 26-20-14-103-000.028-002 PT SW NW 14-3-9.30 AC 1 This form MUST be returned to County Auditor'soffice. Please do NOT send this form back with your tax payment to the county treasurer. —, _____ _ _, ____PART 2:TAXPAYER INFORMATION - .,....er1 — -- First Middle 1 Last TA el< R - Sc h m 1)`i yailing Address(number and street,city,state,and ZIP code) t l Same as property address ND I / ; -VD I3a I D7 Yr\A-e,(Le cA :L7y 1) 76_ y Spouse ` First Middle Last DDi E 3c ham" ° T Maili w Address(Number and street,city,state,and ZIP code) Same as property address.(g9._, -O . 136.1,0 707 r2nek 4.N. y7&sq l . PART 3:CERTIFICATION - • Each undersigned certifies.under penalty of perjury.that the above and foregoing information is true and corcect 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. I Owner I Signature - 40 Date PART 4:ADDITIONAL INFORMATION - • •