Homestead_HasenourINDIANA SALES DISCLOSURE FORM SDF ID: Page 2
PREPARE
CHRISTINA M LENFERS CLOSING AGENT
Preparerof the Sales Disclosure Farm Tide
501 MAIN ST STE 101 BOSSE TITLE CO
Address (NumberandStreet) Company
EVANSVILLE IN 47708 8124214000
City. Since, and ZIP Code Telephone Number E-mail
_133ELLERJO�GRANTOR(S)
ROBERT BERRY PERSONAL REPRESENTATIVE OF THE
ESTATE OF MARY F PRICE
Seller - Name as appearsim conveyance document
203 S TEKC)PPFL
Seller 2 - Name as appears an conveyance document
Address (NumberanuStreet)
EVANSVILLE IN 47712
Address (Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and On ete as requir by law, and !separed in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
SignatorsofSeller Signature ef 11
ROBERT BERRY, PERSONAL REP 11105/2010
Printed Name ofSeller Skim n ..... DD Printed NamonfSeller Sim; Dam (MMIDDIYYYY)
A P P L I C AT 10 N FO R P R 0 P E R T.YLTAXD E D U C T 10 N S _- I D E N T I FY.,zA L U I T E M S -T H A T-A P P L Y
JUDITH E HASENOUR
Buyer l- Nameasappearson conveys document
�5
Buyer 2- Name as appears on conveyance document
Ad fllumbsrmid Street)
Address(Numberamisanmr)
, HAUBSTACIT IN 47639
THE SAM DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
E
YES NO CONDITION YES NO CONDITION
FVJ❑ F-1 1. Will this property be the buyer's primary
3. Homestead
residence? Provide complete address of primary
4. Solar Energy Heating/Cooling System
residence, including county:
❑ S. Wind Power Device
❑ Z 6. Hydroelectric Power Device
[:] [2] 7. Geothermal Energy Heating/Cooling Device
8. is this property a residential rental property?
City, Some ZIP Code County
f-1 ❑ 2. Does the buyer have homestead in Indiana to be
a
vacated for this residence? If yes, provide
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.)
cgw_
Address (Number and Street)
City, Siam ZIP Code County
�..Il
.
Primary Property mviier contact name E
STATE FORM 53560(V/8-lo) 7RBASURFA F00.NnIA
APPROVED BY STATE BOARD OF ArcOUNTS.3071 PRESCRIBED BY 731E DFPARME\IOALCAI.GO%TRNMEWT FINANCE IC 41.1-'1d5
' Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS .
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HEA 1344-2009 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 be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
. PART I: PROPERTY INFORMATION
. Taxpayer Name Location Address
. Price, JamesH/MaryF
500 W PLUM .-
NEW HARMONY IN 47631
2911
Judith EHasenour 11010011_n111011010111III0100011111l0101 ill Ii:1110111f10111100119iiti01111u
500 W Plum St
• HAUBSTADT IN 47639
•
.State Parcel Number Legal Description
—26-22-01-201-000.318-0091 PT E 1-4-11 .8113 AC
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. `
N. - PART 2: TAXPAYER INFORMATION•
ON. . I - First // Middle Last
IA bi'* K � /a i AC aSennu r
Mailing Address(number and street.city.state,and ZIP code) 1 7l - / �e as property address .
550 l.() 5101a f ✓✓8 {aa,� slaGtt1 /(/ 47637 .
•
Spouse First Middle ` Last
410A/e— .
. Million—Add—Si(Number aid street,city.state,avid"LIP code).. - ----`-. _ - --El-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)
I I 1. I I I I I State
. 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 Dal
.
( )
PART 4: ADDITIONAL INFORMATION
•