HomeMy WebLinkAboutHomestead_Stallingsf]: \\Cal UFlrr
D. PREPARER a ti
Preparerofth: Sales Disclosure Form
400 PEARL STREET, SUITE 204
ad u(Number and Street)
®V ALBANY, IN 47150
City, State, and ZIP Cade
Seller 1 -Nome as appears on conveyance document
knowledge and belief, is true, correct
and complete as re��] /ui�Qr d by law, and is prepared in accordance with
� IC 6- 1.1 -S.S, "Real Property ` _Sales Disclosure Act".
Sig al eller Signatureo ller
AARYJAW& -T EFi1 11/08/2010 TONYAS.SHAKE 11108/2010
Address (Number and Street)
HAZELTON, IN 47640
Address (Number and Street)
HAZELTON, IN 47640
City, State, and ZIP Cade
THAT APPLY-
document
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDURIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
✓� 1. Will this property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
Address (Number and Street)
City, State ZIP Cade County
[� 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
udin c uq nty:
Addipss (NumberaMStmet) �C
�,- uc��vr. \� `- kllo4y �i4Son
City, State ZIP Cade County
❑ 3. Homestead
ng /Cooling System
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating /Cooling Device
❑ E✓ 8. Is this property a residential rental property?
❑ n✓ 9. Would you like to receive tax statements for this
property via e-mail? (Provide contact information
below. Please see instructions for more information.
Not available in all counties)
a 6a -o a - 57-11:5 a_)O , (F04-0/7
ownermntact 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.)
I& azure ofBuyerl Signa ofBuyer2 /Spouse
STALLINGS 11/08/2010 J CALLINGS 11/08/2010
Printed
Last 5 digits of Buyer 1 Driver's State Last 5 Digits of5ocial Security Number Last 5 digits of Buyer 2 /Spouse Driver's State Last 5 Digits of Social Security
License /ID 10ther Number I Number License /ID /Other Number
1v\
STATE FORM 53564 OW S-Iq TREASURER FORM TSIA
APPROVED BY STATE BOARD OF ACCOUNTS.YW PRESCRIHF➢BY THE DFPARTME\T OF LO CAL GOVERNMENT FTNA`CE IC 61.1-I2$1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPER Y 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
,• FILE D 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
OCT 1 3 2011 Taxpayer Name Location Address
C Toler, Mary Jane
•
4669 E Dead Level Rd
GIBSON COUNTY AUDITOR HAZLETON IN 47640
24
Brian Stallings III11111i _IIIU11111I1111IIII[Iilili III [Immmmp_IIIIIIDII LIICII 111111IIII111 II
4669 E Dead Level Rd
HAZLETON IN 47640-9368
li"'ill'lllIll'!'1illllll1tt1IlSttl"ttllllllt1ttlF1'li'lli1illl State Parcel Number Legal Description
26-02-57-113-000.806-017 PT MD 113 1-10 1 AC
• o
./
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 .
Ow,.c First . Middle - - Last
Mailing Address(number and street,city,state,and ZIP code) I X.mc as property address
a. d� \tuJ d. �1 �.,JJJuLouth)
Spouse First n Middle Last
Mailing Address(Number and street,city,state,and ZIP code) - - --( �tTe as property addras - - '"'-- - —
:
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
-
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