Homestead_Willis (2)ri
'f'INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Andress (Number and Sneer)
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E. SE LEk(S)/ GRANTORS )'>- '-�----
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(Je\ier k
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ppean on conveyance document
Nale?OCII"�L -� a\
Selk, 2 - Name as pears. c.;aI�
-P . 0 , a0Q Uyco k S*,
Address
`{7683
dress (Number a ;d Street)
C-1-761B
'ffanul,�11�jct) nJ
Under penalties of perjury, I hereby certify that this Sales Disclosure, o hebest of my knowledge and belief, is true, correct
and co lete as required by law, and is prepared in accordance wi C6-1.1.5.5,"Real P operVales Disclosure Act".
1.
Signature ofSelle t fSellerLI
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Prince NmneofSeller on Date MM /DD IYYM 15rmted Name o(Seller Sign Date (MM/D0/yYYY)
F. UYER(S)/ GRANTEE (S) -APPLICATION FOR'DEDUCT[ONSAND.CREDITS=IDENTIFY-.ALI:,ITEMS-THATTAPPLY.,-i,������--',�-:.
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conveyance t-�. r
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guy,, 2 -- me as appears on conveyana�ZTQCSki
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�,J,6,. �aX 3y8 !3* r" 3�
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1Kddresoffumler Street)
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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
1. Will this property be the buyer's primary
R ❑ 3. Homestead
residence? Provide complete address of primary
❑ ❑ 4. Solar Energy Heating/Cooling System
residence, including county:
❑ ❑ S. Wind Power Device
❑ C-] 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heating/Cooling Device
❑ El 8. Is this property a residential rental property?
City. State ZIP Code county
❑ VJ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide complete address of
residence vacating, including county:
3023
f12 ,5-
Address (Number and treer)
Cit,State ZIPCodc County
Under penalties of perjury, I 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".
12110,Zlk t9 . 11 &L
Signature of Bayer_ 9 9 USl
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2 e 0- 1
Printed .V..e of8mver I ��d Z";1 Sign Date (MMIDDIYYM
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STATE FORM 535.4113”-101 TR:ASOALR 10PM 1S-IA
.■PPROVE.D BY Ad tE atnRO OF A((( -Nrs.'-rte ?RISCLIBED BY tEL OEFARIMESI OF LOALCO\FA'MNI!L%AMI IC b1.:-4.1
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
• FILET)Princeton,IN 47670 more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud caw;higher tax bilk for all:therefore,
• HEA 1344-2009 requites taxpayers who receive the homestead standard deduction to verify that they are eligible top teethe the
benefit and to pawide 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 crate tool;that will help county officials eliminate homestead fraud.•APR 13 2012 . . , PART I:PROPERTY INFORMATION . . .
Taxpayer Name Location Address
C. .r Willis,Azel W/Angela D
513 WASHINGTON ST
GIBSON COUNTY AUDITOR SOMERVI LE Ida-crtsss
2784
a _eel I Ills IIHIOIII IIIIIIIIIII II]II ICI 11111111 Ell III 111111 I II Hill II_IIII IIII1
10228 E Michigan S
IN 47683
State Parcel Number Legal Description
26-20-02-401-000.283-003 BARRETT ADD 31/32/33/34/30
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.
-1 • • e • PART 2:TAXPAYER INFORMATION( - --.
.er I First Middle Last
Azet Moline ji)/ l/ 5
. • _ . number and street.city.state.and ZIP code) ■ Same as property address
50L$ S. 1/0ush'tn5+on St. Oakland city , L . Li T06,0 No
'-.
Spouse First Middle - Last
Rn9eln Dawn VJI II is
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
--50(1$---S.U�4511tn91on3} . Datl`nd Cif=9,.)n .-- 414.1,0 - Na
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 Date
PART 4:ADDITIONAL INFORMATION . • . •