Homestead_FetcherIYDIANA SALES DISCLOSURE FORD7 SDF ID: Paee
D. PREPARER - ._,:-... - . : ,�..-: _ - — .
LANA C. HARPER CLOSER
PreporerofrheSalaDis�lomreForm Title
'19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES. LLC
9ddres (NUmber and Sbee[J Company
EVANSVILLE. IN 47708
Email
- Nome as appears om m�ve}nnre dorummt
Addr� (A'mnber ond Suee[J
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E-mall TeleohoneNumber E�mail
Under penal[ies of perjury, 1 hereby certify that [his Sales Disclosure, to [he bes[ of my knowledge and belief, is [rue, correc[
an���l�as re�� by�v, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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ay�, i
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THE SALES DISCLOSURE FORM FIdY BE OSED TO dPPL1' FOR CERTAIR pEDUGT10N5 FUI
res no mno�nos
�✓ � 1. 4Vi11 [his property be [he buyer's prin ry
residence? Provide complete address f pn
residence, induding county:
ao�� 2��k. �1
Addres(Numberand5veetJ !
WQI � �E. U�UbS �„�
Ciry.Sm�eZ1 Cade Counry
_ 2. Does the buyer have a homes[ead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence being vaca[ed,
including county:
vyoom�e o(sene�
Dr,z�,�v;,'l!P �,U y�c���
C!N Smce, and 2/P Code
APPLY.
❑� ❑ 3.
. o ar Energy Hea[ing/Cooling System
� Q✓ 5. Wind Power Device
❑ Q 6. Hydroelec[ric Power Device
❑ ❑J 7. Geothermal Energy Heating/Cooling Device
� �✓ 8. Is this property a residen[ial rental property?
❑ ❑J 9. Would you like [o receive tax statements for this
proper[y via e-mail? (Provide mntact information
belaw. Please see instructions for more information.
Notavaila6le in all counties.)
Addrus (M1'umber and SveetJ
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance wi[h IC 64.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
being file
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SignomreofBuyer] I Signao�reo(Buyer2/Spause
Pnn dLegolNameo/8o erl Si9nOC[e(MSI/OD/11YIJ
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LastSdigi[so�BuyerlDriver's Smte LastSDigi[so(SacialSecunryNumber
License/ID/Other Number
Number License/ID/OtherNumber
STATE FIXbl SJWQa/>-tul IRMSUR R FORM rs.IA
...Pain En Pl TT\TE WA\R:OF 1CCI•NT,.7.M PRE:i 111ED BYnW.mTARTVLT OF LOALCOaAIL'I t L\l`.(F IC 11.1ai.&!
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 thi>deduction becomes
Princeton, IN 47670 more beneficial.there is more incentive than ever for homcsnad fraud.Homon-ad fraud causes higher tare bills for all:therefore,
•
HIiA l344-2201$reyuiro taxpayers who receive the homestead standard deduction to verify that they are eligible to receise the
T T\ fumes. [hi to orm ti will be identifying confidential ir,lirrn d can necessary brr to ssed county government
zed county to better The monitor
Department homestead
J
IN L\ filinc.The nformal on will be kept confidential and can only be amrsed by authorized county oRicials.The Department of
1.001 Gorenartcnt Finance will use this information to acne tool>:hat will help county officials eliminate homestead fraud.
PART 1:PROPERTY INFORMATION
MAY 11 2012 Taxpayer Name Location Address
Green Meadows Construction Inc
C. .
206 E ROCK RD
GIBSON COUNTY AUDITOR OWENSVILLE IN 47665
2015 1
CHAD D FETCHER 1 ill.111.0111011 mil it:full lii1000 0ill hi_.1110101 I_ in un 11011-101101 till
206 ROCK RD
OWENSVILLE IN 47665-9380
"I"IIIIIIi'11IIII1I'I1I11I1Il1t1t1ll1l1lll11llll11'1I'I'll'I1I' State Parcel Number Legal Description
26 18 06-303-004.974-021 ROCK ROAD ESTATE 6 0
- -- - — — — — - -- 18-0b ,3 D0.I,529i—oa 2— — . . _ — -- - —
4- a
a
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-
s 1 PART 2:TAXPAYER INFORMATION
.er I First Middle Last
Chad he_Waki nt it 4Ckv.S
Mailing Address(number and street,city,state.and ZIP code) ® Same as property address
Spouse First Middle Last
m of C,.2 '\o Fay{ r+r���k 1�,°
Mailing Address(Number and street.city,state.and ZIP code) L� Same as property address
PART 3:CERTIFICATION . ' .
Each undersiened 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 171
Date
.