Homestead_Smith (68) •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER
Ray M. Druley Attorney No.4759-26
Prepare:of the Sales Disclosure Form Title
505 N.Church Street, PO Box 146 Law Office of Ray M.Drulev
Address(Number and Street) Company
Fort Branch. IN 47648 812-753-4975 druleylaw(a�yahoo.com
City,State,and ZIP Code Telephone Number E-mail
Shirley Ann Phillios-Flaminn
Seller I-Name as appears on conveyance ment Seller 2-Name as appears on conveyance document'
(/gyp r 2 Aye' Lo -t-21
Address(Number and Street) Address(Number and Street)
(- uh ti il but- 7N ' yZSf-Z
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and mplete as required by law,and is prepar:d in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Shirley Ann Phillins-Flaminn March 23 2015
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Date(MM/DD/YYYI)
'F.BUYER(S)/GRANTEE(S):=-JAPPCICATI0NIFOR PROPERTY4FAX DEDUCTIONS=IDENTIFY AI I4'h1S •HA P ' . ' -
Anthony Brian Smith
-•rso. an are doarme t Buyer Name as appears on conveyance document
ll !I•.5. .oul1/rt- Fl MAR 27 2015
A dress(Number and Street) Address(Number and Street)
Pr;in cetah IN '/7170
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION eBV8A14L
[I� ❑ 1.Will this property be the buyer's primary [ 3.Homestea'
residence? Provide complete address of primary 4.Solar Energy Heating/Cooling System
residence,including county: ❑
(7(( 5 $i,f ule yd ,_,,,/ p1 S.Wind Power Device
Arig N41 cp td)h 57 ii1 7h'7D ❑ el 6.Hydroelectric
eoth mal Power eating
y. /.� Gibson ❑ 0 7,Geothermal Energy Heating/Cooling Device
City,State ZIP Code / County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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.•s0 Oval aselna ,I .
Address(Number and Street) ' a6—/A _/8 . 30d 0
- 0 . 68/—o xS
City,State ZIP Code County
ail
CLAIM FOR HOMESTEAD PROPERTY TAX�{ A��� FORM ��
; STANDARD / SUPPLEMENTAL DEDUCTIONII A �
S s�ce Form so�3 (R�2 � s-w) � . HC10
�' � PreuribedbytheDepartmentMLOralGovemmefrtFnance JAN 15�2013 �
INSTRUCTIONS: See reverse side for filing insVUCtions.
. �
I(We) certify that I(vre) occupied as my (our) prindpal
place of residence w am (ar buying the lollowing described real property for which a Homestead Property Tax Standard Deduction is hereby daimed
under conVaG on the date fhis applicalion is filetl, (date o/filing): '
�(We) own ❑ Am (are) buying under remrded conVact
❑ Am (are) entltled to occupy as a tenant-stockholder of a cooperetive housing corporetion
� Have a benefidal interest in the wst or the right to occupy the properry under tlie tertns of a qualified personai residence Wst
•- • .
Name of daima�n (kyal neme) � � '
$odal Seariry
�
Sodal Seamty rwmEa o1 daimant's spouse (las! (rvE Olgds) Drivers Gcenu / ICrntifration / Other number Iswing State
of daima�rt's spouse (la9 fiva dgicsJ
• ••� �
II �uymg on conbact, Fee Simple ownefs reme
Reeorders ofice where mnvad is remrtled Remrd number Page
..�. . � . �
Counry TaunshiC ' Ta�g distrid (' fown.thip)
' � /L!/JLQO.Cd)C�
Pa�crJ wmber �egal AesciD� • Is Ihe D�PeMY in 9ueslion: .
' �eal pmperty ❑ AnnwOy assessed modle home (IC 6f.1-7)
tl arry portion W ihe residenilal strucNre a Ne IarW not exceeSu�B me (7 ) acre lhac MmeEiatrJY wrtounds ihat strucwre is used b P�um income. dasmhe Ihe use and paRion
ot Ne proparty ub➢zetl In po0uce income.
d� ia-is-�3o a-� a. 68 �-oa £�
�.. . .: . .
Caumy Township County � Tomaltip
I hereby certify the above sfatements are We, correU and complete. Slgnawre ol / �
X �
PdEress(numbera aveef, -,alete.an LP e) i. �
�v C �,
� • . � • �
�� � �i'. �
LanC not exceeding 1(olre) acre immedlauly �'?�sa, g>°��I°r'�' �
surtoundin residentialim rovements. (�) ' ���"�-�`�x+f*_..,:i,��.33.�::��'.,:>..
�-�A
Other lantl � (2) �}.�°"1� �4f.-y��.,,,•�v` .
Total Wnd (line 1 plusline � (3)
�K, �#a� �,;�ri- .�w M z!f�
ResidenUalimpmvemenborMnually �����9 (4) �j4��`�'�����`�
0.5sessetl MoWk I Manufactured Home 9 �5) _�-.`.-�-^ �,,''" ��?'� z>��'r:. `" f.'}E
Gars e :<��-°<'�...-�c�'�'+i�.:�.���%i��
"'�c`rpQy} �'"'x1i:}: •
Other improvements (6) �.j,g;,.!-.�j,�k� _
Total improvemenb (Ilne / througAline 6j (7)
Total value ( llne 3 Pl�a Ilne n (8)
I hernby certify the above is We, cortect, Sigriature af 0.ssessor Date signea (month, day, yea�
and wmplete.
Veifying aman - Sp7nature of Auditar Date signetl (rtronf�. daY. Y��I
�.-� � � � •
2(1 _ pay 20 Lesser ot 60% of the assessed vAue of the homestead or $45,000
NdwUhs7aMfig any oUrerpro�.ivon. the sum oI Ne GedccL'ons provMed in IC 6-f. f-12 to e mo6�1e Mrtre lhat fs $
nat essesmd es real pmperty w lo e menu/acN�ed horne Ihat a nof essested es real properry meY not exceed
wrefiatl (f2� d Na assassed value N Ne moEde �wrre or manu/acturetl home.
Sigrature o(PLEitw ' �ate signeE (rtronth, daY• Y�