Homestead_Martin-INDIANA SAI.ES DISCLOSIIRF FORM CnF In.
D.PREPARER - -
Preparer ofthe Sales Disclosure m nde
Address (Number ond5trret Company
TOTdL TITLE SERVICES. LLC
Ciry,State,andNP W. FOURT ST, v _ 500 Telephone Number E -moil
EVANSVILLE, IN 47708
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E. SE'L/�LER S GRANTOR S _
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Selfer I Name as appears on conveyanre document
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Seller2 - Name as appears on conveyance document
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jpJd/d- r�es(s \(Numberand S,vleet) ,h I�/,,
Address(NVmberandStreet)
r 1"!1 V�� IIV "(7CJ/UJ
City, State, and ZIP Code
_
E-mail
I Teleahone Number 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 comp a as required bylaw, and is prepared in accordance with 6- 1.1-5.5, "RR/(:aaa] ProjpTa�Jrt�' Sales Disclosure Act ".
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PIfntedN .wd SeII ian Date MM /OD Printed Ncmeo Seller Sl nDate (NH /D AqM
F. BU R GRANTEE S -APPLI - TION F
PROPERTY TAX DEDUCTIONS - IDENTIFY ALL• ITEMS THAT APPLY -� - -
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Buyer Nameasappearsoncanveyance n[
Buyer 2- Name asapp ears on conveyance document
4ddr, (Number and Street)
IcT2 IN 47
Address (Number and Street)
Ciry, Stare, and ZlPCode
City, Start and ZIP Code
Tele hpne Number E-mail
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS F PROPERTY. IDENTIFYALL ETH PPLY.
YES NO CONDITION I YES NO CONDITION
I ❑ 1. Will this property be the buyer's primary
15& ❑ 3. Homestead
residence? Provide complete address of primary
❑ ® 4. Solar Energy Heating /Cooling System
600 residence, including county:
❑ S. Wind Power Device
❑ [� 6. Hydroelectric Power Device
eddress (Nvm'rger and ill, I
��'(�r' `-)
7. Geothermal Energy Heating /Cooling Device
Ciy. Sow ZIP Code Counry
El �y 2. Does the buyer have a homestead in Indiana to be
❑ 0 8. Is this property a residential rental property?
' \ vacated for this residence? If yes, provide
❑ EX 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.)
/ L' ��//77
/a -0x-07 "760 �. a3—o— �/
Address um
Address (Number and Street)
Code County
""
Pn'maryproperry owner contact name E- r}fail
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
bei fi�d��'t?/I/L
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L.gnnatureno uyer} ♦n^ �I'� ^1 2n Signature ofBuyer2 /Spouse
No
Last5 digits of Buyer l Driver's State Last 5 Digits of5ocial Security Number Last 5 digits of Buyer 2 1Spouse Driver's Stow Last 5 Digits of5ocia15ecurity
License /ID /Other Number Number License /ID /Other Number
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• STATE FORMtFyq IR.:1YNI TREASURER FORM TS-IA
.APPROVED BY STATE BOARD Of ACCDOSTS.:VP) PI,EarRIBI•D BY PIE DEPA RTfEST OF LQ:AL GOVERNMENT FDi\CE tc
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married 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.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receise the
benefit and to provide additional identifying information neceseary to allow county government to better monitor homestead
filing._This information will be Lept confidential and can only be accessed by authorized county officials.The Depanment 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 Property Address
Martin, Eric J/Brenda M �
RI bisa. 6
Patoka IN 47666
283
Eric J Martin
6047E 600 N State Parcel Number Legal Description
PATOKA IN 47666-9136
�r�rl��trl�t��ltti�trl��ll�l� ��lr�C'rr��ttt�lt�itll�tlt��� 26-06-07-400-000.030-017 009-00030-00 PT W SE 7-1-95.08 AC
trtrl
_ _ _—.
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
EA-t0
gig Address(number and street.city.state,and ZIP code) Ri•nine as property address
0q7 E Good env KA- zAft 47666
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) Same as properly address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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 1 Signature Date
PART 4:ADDITIONAL INFORMATION