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Homestead_FlahertyA Im V;DIANA SALES DISCLOSURE FORNI SDF ID SOO ID 463205 Page 2 1, D: PREPARER - Samantha Cutsinger Preparer ofthe Sales Dushume Form h* 226 W. Broadway Broadway Title. Inc. Addross (Number and Street) Company Princeton. IN 47670- MSELLER(SyJ GRANTOR CS ri - Joshua A Tinsley Emily A Tinsley sefir, I - Name as appears an con,e,mmr, document SeflorZ Numensuppearson,anvtyuncedocument 7000 E 500 N 7000 E 500 N Address (Number and Street) Address (Number and Street) Pakka, IN 47666- Patoka, IN 47666 - ` .14 Dr1,h.r,Namb,, E-mail Under penaltiS�.o Ilperjurv,lhereb certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct perjury, IT s prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". ��5 Signs Leo Seller z anne 'Alumn F. BUYFR(S)/GRAN PLICATIONTORTROPERTY TAX` DEDUCTIONS-,:IDENTIFYALL-ITE--'T i� Daniel K Flaherty Bayerl -Naau,au!ppm anveyoedocamemt Buyer 2- Nome as appears on mnveyvace document (�N..b.a Street) Address [Number and Street) Vmt;ennes, IN 47591 - City Slate- and ZIP Code CD Score, and ZIP Code E -mail Tetea hone Number E-maii THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO ROPERTY. ]DENT IFN 0, THOSE THAT APPLY. t� YES NO CONDITION YES NO cc 110.1 prima FX1 ❑ 1. Will this property be the buyer's prima 3. Home ad residence? Provide complete address 'mary I ;e—e Heating /Cooling 4 rgy Heating/Cooling System residence, including county: _g--r�5 Wind Power Device 7000 E 500 N [-] E] 6. Hydroelectric Power Device AddressiNumberoodStreet) Patoka, IN 47666 GIBSON ❑ EJ 7. Geothermal Energy Heating/Cooling Device E] © 8. Is this property a residential rental property? cuty' Stare ZIP code County 2. Does the buyer have a homestead in Indiana to be 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.) 6??-,) 9- 0 Address (Number and Street) City, State ZIP Code Loamy I Primarypruperty oumcr,oaaacs name E-mail 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". (Note: Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed.) Signature OfBvye,l S,_cu..m offtuve,2,spmme ()., ; e I M k er-1 /a,-)%-i, Lost 5digitsofBuyer I Driver's Slow Lost 5 Digits ofSocialSecurity Number Last 5 digits of Buyer 2 /Spouse Driver's state Lost 5 Digits ofsociol Security LicenselID10ther Number Number License /10 /Other Number tl� STATE FORM 53560 OU/RIO) TREASURER FRMrs-u ED APPROV BY STATE swan OFAccomns,SW PRESCRIBED BY TOE DEPARTMENT OF LOCAL GOVERNMENT fINAICE IC 6-1.1322.1 Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS e 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 1: PROPERTY INFORMATION • Taxpayer Name Location Address Tinsley, Joshua NEmily A 7000E 500 N PATOKA IN 47666 238 Daniel K Flaherty 11 IHa hII II II niiiiCII ii nil iiiuiiali ilU011_11:111CIIIi I-II fl1111111 Cii II II 7000E 500 N PATOKA IN 47666-9175 � IrPl1lliitl'1111'II' "II'I'I1"i1lli'I1III'II'I'III'l"IIIIIII State Parcel Number Legal Description 26-06-17-200-000.329-01/PT S NE 17 1 9 5.00 AC C-1 •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'ART.2:TAXPAYER INFORMATION . w Der I First Middle Last Oet n ; e I j 1 efh Fla her f.� Mailing Address(number and street,city,state,and ZIP code) o ® Same as property address „, Spouse First Middle Last /1cly f-I Af;5e (6e�fy Mailing Address(Number and strceC city,store and ZIP code) -. ----- - " - _—©-Same as propdrtiaddress - — — QI 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 1 Signature Date