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Home My WebLink AboutHomestead_Amelunke. INDIANAS DISCLOSURE FORM SDF ID: Page 2 tD=i P. REPARHRfrn°Fe?'?#.F``T= a�21K�sii Samantha Cutsinger Preparer of the Sales Disclosure Farm Title 226 W. Broadway Broadway Title- Inc. Address (Number and Street) City, Rate, and ZIP Code Telephone Number E -mel +MEL•EER S ",GRANTOR S �?�sf 3i( .F�1 �' '.' °. t Ya" ? :'`_- :.szw. Vicki L. (Connor) Chandler Seller 1 - Name as appears an conveyance document Seller 2 - Name as appears an tan veyance document 4150 E. McRoberts Rd. Address (Number and Street) Address (Number and Street) Patoka, IN 47666 E -m�(a I I Telephone Number E -mail Under penalties of perjury, 1 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 ". ,(-A -��1m!st�t nrif,_1 J Siyna —� tvrcofr&l Signamreo /Seller Vicki L. (Connor) Chandler ni /05/2010 Pnnmd Na m�eo Seller Dale (XX /DD Prnd Nameo Si nDa[e XX DD .Sion GANE S APPi[ CATjONrF ,ORIPROPER7YTAXiDHDUCTIONS xIDENTIFI"ALI'ITEMSnTHATsAPPCY'z " ; arry Amelunke -Name asa nveyancedocument Buyer 2 -Name as appears on conveyance document 58 S Tara Lane Address Aureberand Stmt) Address (Number and Street) Ft. Branch, IN 47648 City, State and ZIP Code N City, State, and ZIP Code E -mail Tele hone Number E -mail THE SALES DISCLOSURE FORM MAY DE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION I Y NO CONDITION xJ ❑ 1. Will this property be the buyer's primary J ❑ 3. Homestea residence? Provide complete address of primary ❑ x 4. Solar Energy Heating /Cooling System residence, including county: ❑ ❑x S. Wind Power Device 304 West St. ❑ ❑x 6. Hydroelectric Power Device Street) Add. (Number and PFttoka, IN 47666 Gibson ❑ ❑ 7, Geothermal Energy Heating /CoolingDevice E] E) 8. Is this property a residential rental property? City, State ZIP Code Counry F] x❑ 2. Does the buyer have a homestead in Indiana to be ❑ Z 9. Would like to receive tax statements for this vacated for this residence? If yes, provide you complete address of residence being vacated, property via e-mail' (Provide contact information including county: below. Please see instructions %or more information. Not available in all counties.) ,P6 — 0 �k_ / / a00, ;%T k— G'?Q q`•/ Address (Number and Street) City State ZIP Code Counry Primary property owner contact name E -mail Under penalties of perjury, 1 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 in ruination, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is be d) / c Signature o)BuyerV Signature cf BuyerZ /Spouse Larry Amelunke 0 ( / (:88/2010 Last 5 digits o %Buyer2 /Spouse Drivers State Lost S Digits o(Social Security License /ID /0ther Number Number License /ID10ther Number u STATE FORM 5]56A(R3/8-10) TREASURER FOLM1S.IA APPROVED BY STATE BOARD OF ACCOUNTS,NON PRESCRIBED BY TUE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 6-I.I-114-1 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 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 ill benefit and to provide additional identifying information necessary to allow county government to better monitor homestead FILED 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 I: PROPERTY INFORMATION Taxpayer Name Location Address APR 6 2011 Amelunke, Larry C.1).n 304 WEST ST PATOKA IN 47666 601 GIBSON COUNTY AUDITOR Larry Amelunke 1101011100110 II_II 11_11 II 111 III!1100110II]III]II II 304 West St PATOKA IN 47666-9013 IIIIIIIIIIIIIII111111IIIIIIIIIIIIIIIIIIIIIIIIIIII 11111111111 State Parcel Number Legal Description 26-04-25-101-000.538-0201 COLEMAN ENLG 1PT If 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. •j..__-_..______._ _.__ PART?: TA XPAYER INFORMATION ._ _ __ ��/, First (��/\ ,,t ` Middle Rlivv-e ,A , /�j� Last Mailing Address(number and�t,city,state,and ZIP code) Same as property address Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) I I I I I I I I I str.: 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 I Signature Date Telephone `1 t.Signature Date Telephone ( ) PART 4: ADDITIONAL INFORMATION n'• CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR • / a_ ,. STANDARD/SUPPLEMENTAL DEDUCTION z State Fon Hct n 5473(R12/6-09) .� .0 et Prescribed by the Department of Local Government Finance ' t INSTRUCTIONS:See reverse side for filing instructions. • FEB L -Lulu - ill " - .... ..... CERTIFICATION STATEMENT • - a I(We).".'e �r _- ✓ _� . certify f �}e �/.das my(our)principal place of residence or am ying the following described real property for w•ich a Homestead Properly Tax Stabdard Degyction is hereby claimed f; (daer contract on the date application is filed, te of filing): "'BON COUNTY AUDITOR (We)own ❑ Am(are)buying under recorded contract ❑ 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 qualified personal residence trust -CLAIMANT'S INFORMATION „ , . . - CONTRACT RECORDED' . _ -If buying on contract,Fee Simple owners name Recorders office where contract is recorded Record number Page - .. - . . PROPERTY DESCRIPTION - ' . . County Township Taxing distpct(Cn,town,to hi. Parcel number Legal esaiption Is(- •perty in questio-- q4-OLf -Z 5-0D I -CO 3 a '0ox�5/ !F.eal property salty a4sassed mobile home(IC 6-1.1-7) ®If any portion of the residential structure or the land not exceeding one(1)acre that immediately su . ds that structure is us of the property u income,describe the use and portion tlized to produce income. . �'o �m�„ '_ / PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES • County r... Township County Township I hereby certify the above statements are true,correct and complete. Iatur� nt / - .dre - .,street, : ,sl'atef and ZIP.•.e) � V ( V 9 0K , N GOe i I I ASSESSED VALUE I HOMESTEAD -I NON-RESIDENTIAL ASSESSOR USE ONLY TRUE TAX VALUE - . _ •�' .I AT 100%OF TTV VALUE a VALUE not exceeding improvements.immediately i -ro { s - �et surrounding (1) 7 + ttea, _; Other land (2) r „._ ._y;STA:": • Total land(line 1 plus line 2) (3) Dwelling (4) -' #' c t'i`t''t: Residential Improvements or Annually 4.-- •+ - +"�'-�+v€t'.`.8-., Assessed Mobile I Manufactured Home Garage (5) S rV1ta An try?;' Other improvements (6) mot , +-= Total improvements(line 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year) and complete. Verifying action-Signature of Auditor Date signed(month,day,year) - , - - - • •- i. , " ., ,• STANDARD DEDUCTION ALLOWANCE - - •• - 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(112)of the assessed value of the mobile home or manufactured home. Signature of Auditor Date signed(month,day,year) -