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HomeMy WebLinkAboutHomestead_CarsonC I INDIANA SALES DISCLOSURE FORM SDFID SDO ID 713684 Page: D,PREPAREIR - - - Shelly McDaruel SETTLEMENT COORDINATOR Preporer of the Sales Dudosure Form Due 290 BILMAR DRIVE SECURED LENDING SERVICES Address (Number and SUeet) Company PITTSBURGH, PA 15205 - E. SELLERS GRANTOR S Household Finance Corporation III Seller 1 Name as appeors on rume.vnce duovment ShcerZ Nome os uapron an mnvevunce da'umem 931 CORPORATE CENTER DRIVE Address(Namber and Street) Address (Number and Sa tv) POMONA, CA 91768 - CiD', Sm:q and ZIP Code 044, Sunc, and ZIP Code E -mall Tele hone 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 an c Iplet� uired by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". ry at" a, Sr /lee .Signature af5[Iler F. BUYERS GRANTEES - APPLICATION FOR PROPERTY TAX DEDUCTIONS, IDENTIFY ALL ITEMS THAT APPLYr Anthony J Carson Buyer t h'mne ns oppmrs on ronvrwnce ✓arvmen: Bmrer? Name us rtppmrsan convrvnnce dacumcnt 307 S MAIN STREET Address (A'umber and Street) Address [Number and Street) PATOKA, IN 47666 - City. State. and ZIP Cude Cmv, State, and ZIP Code Tde Mme Numher E -umil Td hane Number E -mail THE SALES DISCLOSURE FORAI MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION x❑ ❑ 1. Will this property be the buyer's primary Q ❑ 3. Homestead residence? Provide complete address o(primary ❑ © 4. Solar Energy Ileating /Cooling System residence, including county: ❑ © S. Wind Power Device 307 SOUTH MAIN STREET ❑ © 6. Hydroelectric Power Device Address(NUmberand Streer) PATOKA, IN 47666 GIBSON ❑ © 7 Geothermal Energy Heating /Cooling Device ❑ © B, Is this property a residential rental property? City. Sma ZIP Code Cauarc ❑ 2. Does the buyer have homestead in Indiana to be a vacated for this residence? If yes, provide ❑ ❑ 9, Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail? (Provide contact information including county: below. Please see instructions for more information. Not available in all counties.) A ddres (A'umber and Street) o1G -y -- " .ao�/- City Smte ZIP Code County Rimarvproperty orvner mrtact name f -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.) Signature ef Bay erl 5ig=za -e of Buyrr2 /Spouse Printed Legal Name of Buyer l Sign Dote(umlDolmil Printed Legal Name afBuyer 2 1Spouse Sign Dm (UA/m)/YYYI IN Last 5 digits al-Buyer l Driver's State Last 5 Digits of Social Security Number Last S digit/ afBuyer2 /Spouse Driver's State Last 5 Digits of5ocial Security License /ID10ther Number Number license /ID /other Number STATE rORN'sW,NI$'-I.I 111:ASURLK 10KM MIA APPROVED py?ATE 311tkn Or:,(CI.NEC.1.r rRasetamo III nu.utrARo.ns r OF 10_u.COVRSsusn l NA...CC ICS:.t aI Gibson CoC4ity Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS'.` 107 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 caries higher ax bills for ell:thcefore. IfEA 1344-209 requires taxpayers who receive the homestead standarJ deduction to verify that they are eligible to receive the t benefit and to prinide additional idenufyim_ information necessary to allow county government to batty monitor homcaead flings.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 comic tads that will help county officials eliminate homestead fraud. - - PART 1: PROPERTY INFORMATION ' Taxpayer Name Location Address —. Household Finance Corporation III 307 S MAIN ST PATOKA IN 47666 612 AnthonyJ Carson III�I I I_�II�II�I I II I�II I: III 4I II I I II II-II�II I I I I II_I I�II�II01�I�II�II 307 S Main St PATOKA IN 47666-9000 Irlllrll1lll'X11"1Illllll11lrlIll'llllll1"11'I1III"1rll1llllrl State Parcel Number Legal Description 26-04-25-102-000.204-020 SMITHLAND DIV1OPTn1PT 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. stir 1 First _. Middle .._ . —______- . . - _. Last. _ - � l�q Mailing Address(nymbcr and street,city,stale,and ZIP code) Same as property address /I 3c1 5.9,,,q, 7Y7G 1 l 9 ID kg ,�AJ r / vVUk7 0 Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) 0 Same as properly 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 Snit . 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 \ ) PART 4:ADDITIONAL INFORMATION