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Homestead_Garrett (2) • INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER Christina Ferguson Closing Agent Preparer of the Sales Disclosure Form Tide 501 Main St. Suite 101 Bosse Title Company Address(Number and Street) Company Evansville, IN 47708 812-421-4000 City,State,and ZIP Code Telephone Number E-mail E:SELLERS)/GRANTOR(S)s. Diann K Shackelford Garrett Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 102 S.West St. Address(Number and Street) Address(Number and Street) Haubstadt IN 47639 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct rid complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". `:.. mil. . . . I Lk l.. Signature of Seller Signature of Seller Diann K Shackelford Garrett 10(08(2014 Printed Name of Seller Sian Date(MM/DD/YYn) Printed Name ofSeller Sion Date(HM/DD/YYtt) F.BIIYER(SlJGRANTEE(S)=APPLICATION FOR PROPERTY TAX DEDUCTIONSL IDENTIFYALL ITE HqT PPL i - Diann K. Garrett 1 J , tuye rs on conveyance document Buyer 2-Name as appears on conveyance ocument 102 S.West St. OCT 20 2014 Address(Number and Street) Address(Number and Street) Haubstadt, IN 47639 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead residence? Provide complete address of primary U 4.Solar Energy Heating/Cooling System residence,including county: ❑ 102 s West St S.Wind Power Device Address(Number and Street) ❑ IN 6.Hydroelectric Power Device Haubstadt, IN 47639 Gibson ❑ Fl 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ ig Fl 2.Does the buyer have a homestead in Indiana to be ❑ 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. Not available in all counties.) Address(Number and Street) 026 /? -3/ - 3o3 - oo6 . y6o - 009 City,State ZIP Code County Primary property owner contact name E-mail CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION r State Form 5473 (8215 -92) INSTRUCTIONS: See reverse side for filing instructions. SIC y- i3-a.� FORM HC10 YEAR CERTIFICATI N STATEMENT r � I (We) certify at on y 9_ I (We) occupied as our principal place of residence t6giollowing described real property for which a Homestead Property Tax C et i�hpfebnclaimed: ❑ 1 (We) owned ❑ Are buying under contract LL WW ❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro or is buyin un a cont I. p CONTRACT RECORDED ON CO U" It buying on contract. Fee Simple owner's name Recorder's office where contract is recorded - Record number - Page PROPERTY DESCRIPTION Co ry To ip Taxing dist �t "ry, town wns rte number Leg scription O /3 -©v X6 o - oo If any portion of the residential structure or the land not exceeding one (1) acre that immedatey surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES County Township County Township natu of daimant ®ereby certify the above statements are true, correct and complete. lA- Address (number and street, dry, state. ZIP code) a S �5 nJ C; 7 G ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON - RESIDENTIAL VALUE VALUE VALUE VALUE Land not exceeding 1 (one) acre immediately (1) surrounding residential improvements. Other land (2) Total land (line I plus line 2) (3) Dwelling (4) Residential improvements Garage (5) Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true, Correct, and Signature of Assesor Date signed complete" verifying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE 19 Pay 19 Le er of 1/2 Homestead $ a' $2,000 Signature of Auditor Da " ned coat I ORM MM.IR•/FoO TREASURER FORM MIA PARTMLNTOT LOCAL APIPROOE0 TO HOMESTEADrP OPERTYROWNERS Gibson County Auditor 101 N Main PRINCETON IN 47670 Individuals and tarried 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. • A HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to serif),that they are eligible to teethe the benefit and to proide additional identifying information necessary to allow county government to better monitor homestead •./ __J filing.This information will he Rep confidential and can only he accessed by muthnri/eJ county officials.The Ilepannment of Local Goscmment Finance will use this information to create tools that will help county officials eliminate homestead feud. Mpg II ^"t PART I: PROPERTY INFORMATION Taxpayer Name Property Address C. Garrett, Diann K 102 S West GIBSON COUNTY ADD TOR Haubsmdt IN 47639 3117 Diann K Garrett P O Box 72 State Parcel Number Legal Description HAUBSTADT IN 47639-0072 ltlrtllttt�tllrttt lIrIt�tt lIt ttlltrtltttlrtlt lltttlrtltltt11t1 26-19-31-303-000.460-00y013-00460-00 ORIGINAL PLAN 153/152 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 yy. First Middle Cr" ly`} Last �--...1'I v� AI 1` tg Address(number and street,city,state,and ZIP code) Frame as property address Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below) SORB PART 3:CERTIFICATION - - - - m - ---- — — 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 `y/ Date • .i