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Home My WebLink AboutHomestead_DyalE (i C INDIANA SALES DISCLOSURE FORAI SDF ID 26 -2009- 1000237 Page 2 LENFERS BOSSE TITLE CO CLOSING AGENT I 'CHRIS Preparer of the Sales Disclosure Form Tide 501 MAIN ST STE 101 BOSSE TITLE CO Address (Number and Street) Compam• EVANSVILLE, IN 47708 ( ' Cin•, State, and ZIP Code Telephone Number E -mail pb• -, _1 .r NVMW LAUREN 0 MIXNER NKA LAUREN m UTT� Seller - Name as appears on conveyance document Seller - Name as appears on conveyance document 558 KINGS WAY Address (Number and Street) Address ('umber and Street) ELIZABETHTOWN, KY 42701 Under penalties of perjury. I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and l7eteas required by last, and is pr pared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". o �Signaure of Seller Signature of Seller Lcu x-o-n M - of, (q .2065 P . ame of Seller Sign Date (,1L18DD1ITYY) Printed Name of Seller Sign Date (AL4f1DD1YY)')7 F!BD] ER($) /GR &\TEE(S) : RISICAlY0)IEOR'DEDUCTIONS*" AtN' DICREDI TS - IDELNTUFYsALC1 rE:iISeTH CTjAPPEY TINA SANDERS G A-q-\o Bgyer - Name as appea on mn a a document Buyer -Name, as appears on conveyance document I- 114 N RACE ST .., an Street) Address (Number and Street) HAUBSTAOT, IN 47639 HE SA 1, ES DISCLOSURE FO RM NIAN'B E USE D TO A PPIA' FO R .% IS DED UCT'I ONS FORTH ISP PERTY. I DENTI FYALL OF TH OS E THAT rJ 1. Will this property be the buyer's primary residence? P ovi rZ-o, 3. Homestead complete address of primary residence, including county: ; 4, Solar Energy H ng/Coolina System 114 N VINE STREET J �. 'in otyer Device Address (Number adStreer) r 6. Hydroelectric Power Device HAUSSTADT, IN 47639 Gibson n 7. Geothermal Energy Heating /Cooling Device Cim State. and ZIP Code Coan9 r S. Is this property residential rental proper)? r - Does the buyer have a homestead to be vacated for this residence? If yes. provide complete address of residence vacating, includin_e counn': Addre s (Number and Street) /I //' �' /- �(/ /� (/� - U (O City. State, and ZIP Code Comm, n er,,PPena ties or-perjury, ere y certl y t at t is a es isc osure, tote est o my now a ge an a ie , is true. correct an ". complete as re . ed by, law,, annd i_s prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act �Sf mrure ofEm-er Signature ofBu'er ' ::J:� n 0(6 /� �I �oZC CJ Printed Name ofBmer Sign Date(1.1UDDU� Printed Name ofBu7er Sign Date(1f.NIDDI)TYI) sntE FORM!3tt-IR: 4M1 TPF ti7lrx FORM1IA nrrnm'ED BY clOt..BOARD Or AM R'.NI a,!vv PAr3WDED BY flu DEPARTMENT GE LOCAL GDtct1MrWt FINANCE IC 6-1.1-L-r.1 Gibson County Auditor i�i N Mein IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples ate limited to one homestead standard deduction.As the receipt of this deduction becomes ,--` more beneficial,there is more incentive than ester for homestead fraud.Homestead fraud causes higher tax bills for an therefore. •1 HEA 134-1-2009 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 he kept confidential and ran only he accessed by authorized county officials.The Depanttent of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION — Taxpayer Name Property Address - Mixner, Lauren 0 — 114 N Vine llaubstadt IN 47639 3089 Tina Sanders 114 N Vine St State Parcel Number Le2a1 Description HAUBSTADT IN 47639-8122 III rr IIItrIIIItt IIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 26-119'-31-301-000.508-009 013-00508-00 ORIGINAL PLAN 109 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 I Last Tea Me d; Co by "t �g Address(number end street,city,state,and ZIP code) pI Same as property address Spouse First Middle Last ZaLJio-ry ,�s+4r Laoy a1 Mailing Address(Number and street city,state,and ZIP code) Same as properly address • . .. - ---- --- 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 Signature Date ( ) PART 4:ADDITIONAL INFORMATION