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INDIANA SALES DISCLOSURE FORM SDF ID 26- 2009 - 1000335
M� Page 2
ID PREPARER
a.
CHRIS LENFERS BOSSE TITLE CO
CLOSING AGENT
Preparer of the Safe Dadmure Form
Tale
501 MAIN ST STE 101
BOSSE TITLE CO
Address (,Vumbvr and Street)
Company
EVANSVILLE, IN 47711
(812)421 -0000
Cim. Srare, and IIP Cade
Telephone NV hot E -mail
IE3SELL:E'R(S)ZGRi1IV1OR(S) `'w�' ''�? "? e�U : -f �- - - -. '�v TVME "`-
_44,,'"-
ALAN M PURCELL
JULI A PURCELL
Seller - Name m appears on con eyonee documem
Seller - Name as appem.* on romevnnce da vmem
PO BOX 113
PO BOX 113
Addren(.VUmbeand Streetl
A (Number a,,.d5,meo
HAUBSTADT, IN 47639
HAUBSTADT, IN 47639
nder penalties of perjury. 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and
omplete as require -- law, and is prRptirod in accordance with IC
1.1 -5.5, "Real Property Sales Disclosure Act ".
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Ste. mreoj5ella '
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Igrt .of Set
Q IdAn Wlkwc c (l'� �
(ce . P�rc P os�is(ao�
Printed A'ame MSeller Sign Dare (AIAUDDITITY)
Primed Name ofSAler Sign Doze (MAl/DDIM1)
F�-B._ ti(Sj/GRr1, TE�E(52 �';RUICwillO l Oli:� 4C CIO S�A.\D O EDLT &3 1 <\L 1Th�tiS 7'IG�1y. EF Y3 .
_
JOSHUA J BITTNER
Bova -,Vane as appears on comeeance dowmem
yer -,Vane as appears on rom evance documeru
913 E SINCLAIR ST
Add,,u (A'onbaandSheen
A s(Number and Streen
FORT BRANCH, IN 47648
SALES DISCLOSURE FORM MAY BE USED TO APPLY F- 'RTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TILAT
F I. Will i - rest ence? Provide complete
r 3. Homestead
address of primary residence, including county:
rl 4. Solar Energy HeatinglCooling System
308 N RACE ST
j 5. Wind Power Device
Address (Numhe, and Srreer)
HAUBSTADT, IN 47639 Gibson
rl 6. Hydroelectric Power Device
Ciro, Srare. ard71P Cade County
❑ 7. Geothermal Energy HeatinglCooline Device
(J 2. Does the buyer have a homestead to be vacated for this residence? If
rl S. Is this prop", a residential rental property?
yes- provide complete address of residence vacating, including county:
9. Would you like to recieve tau statements for this property via
e -mail? (Provide contact information below. Please see the
instructions far more information. Not available in all counties.)
Addresr (.Numbs and5treeq
dL; 9 --�I 1 - eao.�90
On ,.. Same, and LP Code County
Pr fm r , pe youneraumne +name E -mad
-
I
SINE Corp.5!M IRE/}+MI FAEASU[IA FORM:3-1A
APTRT'EO NY 5 MSIE BOUM OF AIYY*e.'r5_YNN PRf OUBED BY T11E DEPARTMENT Or LOCAL GOVERNMENT FINANCE ICVI.1-L'-II.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
a
101 N Main RS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this 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 taxpagera who receive the homestead standard deduction to verify that they an eligible to recehe 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 to accessed by authorized county officials.The Ikpanntent of
Local Government Finance will um this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Purcell, Alan M/Julie A
308 N Race
llaubstadt IN 47639
3087
Joshua J Bittner
308 N Rare St State Parcel Number Legal Description
HAUBSTADT IN 47639
26-19-31-301-000.490-009 013-00490-00 HAUBSTADT 33/34/35
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.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
ti o3 ii 01 is Pie3 51,1-the•-
fit.Address(number end street city,state,and ZIP code) Same as property address
gffit en 4C Agee 31'. Fk,vb ssi dr ,2 // 9763'
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 Part 4 below)
See
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���— ^t/J Date
PART 4: ADDITIONAL INFORMATION
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