HomeMy WebLinkAboutHomestead_Campbell (2)- I .NL`IANA SALES DISCLOSURE FOR_NI SDF ID 26- 2009 - 1000366 1 Page'
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SAMANTHA CUTSINGER BROADWAY TITLE, INC.
® Pmparer of the Sales Disclosore Form Title
226 W. BROADWAY BROADWAY TITLE, INC.
Address (yob .her.(Sarea Cnnpco�,
PRINCETON, IN 47670 (
Ciry, Stw4 and TJP Cab Telephone Number E -mail
E. SFLI :ER(S) /CRANTOR(S)
JOSHUA L FETTER
Seller -Name as appear on conve ance doeumem Seller -.%=e os appears on eoorevaore document
400 W. ELM ST.
Addresr fAumber soul Saver Address r AWoo5er and Streeq
HAUBSTADT, IN 47639
00i .. S.X,e and LP Code dot Sate. and]JY Code
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F -mail Teleph.ne,vumber E -mail
nder penalties of perjury I hereby certify that this Sales Disclosure, to the best of my know ledge and belief, is true, correct and
omplete required by law, and is prepared in accordance with IC 6- LI -SS, "Real Property' Sales Disclosure Act ".
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IDg' sSeller Signature.!Seller
S'os�ua L, Fe,iier
Priraed:Vome of Sdbr Sign Dare (MWDDt Mi Printed A'ome.1 Seller Sign Date (N,WDD;Y)T17
F,RUFER S (CRANTEE(S)-APP.LICATION FOR.DICDHCFIONS AND CREDITS - IDENTIFY ALL ITEMS TIIA1' APPLY'
KRYSTAL D CAMPBELL RUS LL W ELPERS
Byrr -Nome o. .. eva+ree dmnrenr Ryr. -:vane as nppears on rnm'er re doa n•,enr
3810 KENNESAW DR. 9
Addrers lh'vmber raM,lrrne J Arbrerr (Number and So eeri
EVANSVILLE, IN 47725 HAUBSTADT, IN 47639
Rlephone h'unrber E -moil 7,kphane,4'umber E -moil
I'l1E SALES DISCLOSURE FOR ?I NIA V- BE USED TO APPLY FOR CE RTA IS DF.DU 1PFRTY. ID EXTI FY ALL OF 1 HOSE THAT
r I. Will this property be the buyer's primary residence? Provide complete r 3. 1lomestead
address of primary residence, including county: r .nerg}' Heating %Cooling System
400 W. ELM ST.
F' 5, Wind Potter Device
Address byumber anASrreet/
HAUBSTADT, IN 47639 Gibson r 6. Ilydroelec ric Potter Device
Cim. S o, and7JPCcde Coanry r 7. Geothermal Energy Ilcating/Cooling Device
F 2. Does the buyer have a homestead to be vacated for this residence? If r S Is this property a residential rental property?
yes, provide complete address of residence vacating. including county-
F- 9. Would you like to recieve tax statements for this property via
e-mail? (Provide contact informarion below. Please see the
3810 KENNESAW DR,
insuT¢timu for more information. A'oi available in all counties.)
Address (,yuneber and 5rree1
EVANSVILLE, IN 47725 VanderbunJh 7� I -303 _066. 0&0 —00
Coy, Sim,, and 1JP Cade County' FTrimap pm rry sorest Corral name E -rm..l
Under penalties of perjury, 1 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
an,dp ricer's License other numbers are not necessar if no Homestead Deduction is being riled.)
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Liren,'1D %0ther Number
Number l i,ense/1D•Orher Numlrr
STATE FOAM!Iw,IC/awl M.W:tra PoRV:11.1
• APPROVED ST STATE A91ADrW PUSAIMED BY THE DEPAATKENT OF LOC AL tOVELYMG'T FINANCE h'4-I.1-224.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
P INCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
it more beneficial,there is more incentive than net for homestead fraud.Homestead fraud causes higher lax bills for all:therefore.
HEA 13-14-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information ne esmry to allow county government to better monitor homestead
E filings.This information will he kept cnnlidential and can only he accessed by authorized county officials.The Department of
1 I Local Goverment Finance will use this information to create axtis that will help county officials eliminate homestead fraud.
APR PART 1: PROPERTY INFORMATION
2 Taxpayer Name Prnpertv Address
�
e Fetter, Joshua L
GtaSpkc ?r�9/TOF Ilaubstadt I\147639
3096
y54-aJ D.Cam pb2(I
,ISH9Seli-w/-E)perS-
400 WElm St State Parcel Number Legal Description
HAUBSTADT IN 47639-8105
ItlnllutltllnnlltlJululnullllnnlrltllurllrrrlrrrll 26-19-31-303-000.060-009 074-000f60-00 ORIGINAL PLAN
_ — -- - - -- - -- ' —- - - - - - - --
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
•ng Address(number and street.city,state,and ZIP code) Some as property oddness
X100 W . C— Si - H° xbs-ltd+t N q (D39
Spouse First Middle Last
Mailing Address(Number and street,city,state:and ZIP code) Same as properly address
Social Security Number(law[5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
- -
5=-
- 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 Signature I Date
)
PART 4:ADDITIONAL INFORMATION
.