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Homestead_Johnson INDIANA SALES DISCLOSURE FORD? SDF ID: Page 2 a-PREPARER — - • Karen Harbison VP Preparer of the Sales Disclosure Form Tide 803 E State Hwy 68 Haubstadt State Bank Address(Number and Street) Company Haubstadt IN 47639 812-768-5800 kharbison@esbanc-com Ciry.State.and ZIP Code Telephone Number E-mail E.SECLER{S)/GRANTOR(S)--__-- ----- - - - - _-_ - -_ -__----__ -- — Kirk N Peterson Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 4002 E Valley Pass Address(Number and Street) Address(Number and Street) Haubstadt IN 47639 Telephone 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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Seller Signature of Seller Kirk N Peterson 10/01/7013 Printed Name of5eller Sian Date(MM/DO/YYYYI Printed Name of Seller Sian Dote(MM/DDATIYI _F.BUYERS)/GRANTEE(S) APPLICATION,FORD-ROPERTY_TAX DEDUCTIONSiIDENTIFY,ALLITEFIS.THAT,APPhY__-- _ / Christopher D Johnson`/ Angela K Johnson • Sager-l--4:mne-en app,2-3 ulr<onveymre document Buyer 2-Name as appears on conveyance document 735 East Eisenhower Lane 735 East Eisenhower Lane Address(Number and Street) Address(Number and Street) Haubstadt IN 47693 Haubstadt IN 47639 TIIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION I 1' ON 0 ❑ 1.Will this property be the buyer's primary ❑ ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating i�iteQf--1' residence,including county: ❑ 1 AApp--�� 309 E 1025 S 5.Wind Power Device Address(Number and Street) ❑ IZ 6.Hydroelectric Power Device Haubstadt. IN 47639 Gibson ❑ Q 7.Geothermal Energy Heat0C/Fo3lin2Epaice City,State ZIP Code County ID 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 9.Would you like to receiv e star is complete address of residence being vacated, property via a-m I? Pr rmotion including county: below.Please see Iri tg9PMTlYe A aRn. 735 East Eisenhower Lane Not available in all counties.) Address(Number and Street) Haubstadt,IN 47639 - Gibson 26 -1?- 3 /_ %o o- oo/, 91) 6 - o City.State ZIP Code County , me —T.-mail CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 0.--.'+ STANDARD I SUPPLEMENTAL DEDUCTION FORM Sate Form 5473(Rt5/5-14) HC10 Presmxd by the Depar rent of Local Govemment Fiance INSTRUCTIONS:See reverse side for filing instructions. NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are conf•` b. u ('or. • 1.1-;ii ;� -CERTIFICATION STATEMENT' i�'r C' ` I(We) . AMTET�l / �/ e , 3 , -'I/ I. A apt certify that 1(we)ocaPl'+ as'my�o-' 7 cipal place of residence or am(are)buy g the following•i cubed real property under contract for which a Hoglestead Property Tax Standard Deduction is hereby claimed on the date this appli -don is signed, ( ( s®natus20 re): ❑ Own. ❑ Am(are)buying under recorded contract. CU ❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. . ❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a q dence trust. ❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY A _. If b 1leg on contract.Fee Simple owners name - r Reorders office where canna is recorded I Record number Page _ , �.. _ . .__._ _ . __ }PROPERTY DESCRIPTION+'_k:- . E .-- _ -- r ?4w-" Count'/ Township' Taxing distha( lstup) A .4 i I �j / Po ¢ Is the pro. m question: l,-1 93/-Y- o Yoko a V ❑Real property ❑Annually assessed noble borne(/C 5-1.1-7) If any panes of the residenial structure or the land not esceedifp one(I)acre that inufeda:ey surrounds that=care is used to produce income.desaibe the use and prat of the property Itdoed to produce ircme. PROPERTY OWNED ELSEWHERE BY CLAIMANT Sates.Carey,and Township Is claimant vacating a homestead? ❑ Yes ❑ No a:.�l 6mam • I hereby certify the above statements are true,correct,and complete. .l /e Address of correct(number and meet rmy.state.and ZIP Ode) r TL rt Address of vacated homestead.4 ' (number and meet cry.ante,and ZIP Ode) 3O9 e4 F /Od Sca FA At - 1 Land not exceeding one(1)acre immediately (1) surrounding residential improvements Other land (2) Total land(line f plus line 2) (3) Residential Improvements or Dwelling I(4) Annually Assessed Mobile I Manufactured Home Garage (5) Other Improvements (6) Total improvements(line 4 through line 6) (T) Total value (line 3 plus line 7) (8) Signature of Assessor Date signed(m onA day,year)hereby certify the above Is true,correct, and complete. Jethryg adm-S gnaLe ofAW:a e N T -1LE-9 p""'(ncN,day,year) 20 pay 20 Lesser of 60%of the assessed value of the homestead Or 545,000 2015 Notwithstanding any other provision,the um of the deductions provided in IC 6-1.1-12 to a mobile home $ that is no assessed as real properly or to a manufactured home that is not assessed as real propel -y, 4 U not er":.•one-half(1/L)of the assessed value of the mobile home or manufactured home. 1, {Vjrl/1�ia Mp���!! I GIBSON COUNTY '1Tb1-'b- ' 113Y.if / eii1 lAI_ . _ / Al I �` IJ DISTRIBUTION: Ongnal-C yAudaor.FleSamped Copy-Taxpayer