Homestead_Meyer (5) •
INDIANA SALES DISCLOSURE FORM --_SDI:ID:-- --- _ -- - -- - _ Paul
KAREN HARBISON VP •
Pr epare 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
Cry.State.and ZIP Cade Telephone Number F-mad
E.SELLER(S)/GRANTOR(S) . .- - - --: - - L.
- :i._,• . _- L -_- 7: - ._- - . •
TERRY J DEWIG SHARON R DEWIG
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
101 WEST MAPI P ST 301 WEST MAPI P ST
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 4761Q HAUBSTADT IN d7Ale
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 wits IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
c
Signature 00 Signature of Seller J
TERRY J DEWIG 11/14/14 SHARON R DEWIG 11/11/14
Printed Name o;Seller Sian Date PUS/DD/MM Printed Name of Seller Sian Date iu+von/I i it'
F.BUYER(SyGRANTEE(S):-APPLICATION_FORiPROPERTYTAXDEDUGTIONS IDENTIFY-ALL:ITEMS THITAPPLY_-;: _;, j
TRAVIS M MEYER KRISTA LYNN ELPERS
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on ronvtyance document
11488 S 150E 6275 W OLD PRINCETON RD e
Address(Number and Street) Address(Number PRINCETON
Street)
HAUBSTADT IN 47639 OWENSVILLE. IN 47665 t�/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TI IIS PROPERTY. IDENTIFY ALL OFTIIOSE THAT AMA�rO��", . `
YES NO CONDITION YES NO CONDITION N �Ir -
0 ❑ I.Will this property be the buyer's primary ❑ ❑ 3. Homestead r9G0i
residence? Provide complete address of primary ❑ ❑ el.Solar Energy lieatiug/Cooling System TOR
residence,including county: ❑ r.
-7111-WEST MAPLE ST n S.Wind Power Device I
,lddrecs(Number and Street) _. ❑ 17j 6.IJydroelectrie.Pa.verDevice - _I
HAUBSTADT IN 47639 GIBSON ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
1 2 2.Does the buyer have a homestead in Indiana to be ❑ B. Is this property a residential rental property?
vacated for this residence? If yes, provide ❑ ❑ 9.Would you like to receive tax statements fin this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more infa"natiatl.
j Not available in all counties.)
Address(Number and Street) or‘ P 5‘ /o cr. ,,f /o
Dry,Stow ZIP Code County
Primary property owner contact name E-mail
SAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
S STANDARD/SUPPLEMENTAL DEDUCTION HCIO
.2 Prescribed State Form 5473(R15/St4) e
Prescribed by the Department of Local Government Finance /
INSTRUCTIONS:See reverse side for filing instructions. _ I"
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. - .
r•n - - - - - CERTIFICATION STATEMENT - - " ' - — _ '
I(We)I���/�_—I /� /� - - certify ( )occupied _my(our)e P !'
y certi that I we Dose led as m n:..l L014
place of residence or am(are)buying the following de/bed real property under contract for which a Homestead Property T�-x Standard
Deduction is hereby claimed on the date this application is signed, (date of signature) i e):-
❑ Own. ❑ Am(are)buying under recorded contract. 0' ON CO e, t'
ID Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. UNTV A
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust. I UDJTOR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
='x F _ - -- -::CIAIMANCS INFORMATION.v-:-. ._ ._.7.---I, _ _ .
TT,",
U buying on contact.Fee Simple owners name
Recorders o5ce where reenact is recorded 1 Record number 1 Page
� t -1 _--.-_i � -'PROPERTY UESGRIPTION!_ - ,.TT:., _ S T -' -_-__e.e xnTi7
County / Township Ta v •dist• N.town,`.manic)
6 Ot- VIII 2./Lsil A
Parcel number Legal desoiption Is the• ••ay in question
Real propey ❑Annually assessed noble home(IC 6-1.1-1)
If any pa••1rirA resider al s'-flax or the land rot exceeding one(1)ao inr
e that nedale y eurrou • Nat structure is used to produce income,describe Lire use and pawn
of the•••-F .d'¢ed to pry trmne.
r%'-/dc 36-jCb-Q orifo-aa9
State,County,and T ti Is claimant vacating a homestead?
O ❑ Yes ❑ No
Signature of cla"uram
I hereby certify the above statements are true,correct,and complete. J /P�1/
Address of contact(number and sreet aty.awl,.and ZIP code) 4t.6 39 Address of vacated tamest' ,d any(numb end areal c Sate,and ZIP cede)
iC w Ma S+ 0,
Land not exceeding one(1)acre immediately 1(1)
surrounding residential improvements
•
Other land 1(2)
Total land(line 1 plus line 2) 1(3)
Residential Improvements or Dwelling I(4)
Annually Assessed Mobile/ .
Manufactured Home Garage 1(5)
Other improvements (6)
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.
Venyeg action-Signature of Auditor Dare signed(month.dag year)
• I V •
_ '
.'±' - .—_ "s y„ `--••—".STANDARD.DEDUCT ON ALLOWANCE s 'Y . _I9 MF3 N' --eta
1 !W
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 i
Not•thstarding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home 5 DEC 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may 20114
not exceed one-half(1/2)of the assessed value of the noble home or manufactured home.
Signature ofAWdor / Date sigrod(madh,day, a�
DISTRIBUTION: Orig4ml-CounyAditor,FreStamped Copy-Taxpayer
t�)BSON COUNTY AUDITOR