Homestead_SimpsonINDIANA SALES DISCLOSURE FORM SDFID: P 2
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Steven L. Whitehead Attorney
Preparerof the Soles Disclosure Form Title
111 North Hart Street
®Address (Number andSmeet) Company
Princeton, Indiana 47670
City, State, and7dPCode Telephone Number E -mail
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Billie D. Chapman
Loretta Chapman
Seller 1 - Name as appears on conveyance document
108 S- Wren I ane
Seller 2 - Name as appears on conveyance document
108 S. Wren I ane
Address (Number and street)
Patoka- Indiana 47666
Address (Number and Street)
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-S.5, "Real Pnrooperty, Sales Disclosure Act ".
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Signatureafseger D signature afseller
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Billie D. Chapman -�a-la Loretta Chap man -aa -la
Printed Name o Seller Sign Dow oistlw Printed Nameo Seller S" n Date(MM/DD/YYYYI
'F;,B TEES ; APP CATION- FOR ` PROP. ERTY - TAX= DEDUCTIONS=( DENTIFY,AL'C:ITEMSTHATAP.PL'Y.-
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P S Sim on
Buyer I - Name as n an conveyance document
Buyer 2 - Name as appears on conveyance document
108 S. Wren Lane
Address (Number andStreey
Address(Numberand Street)
Patoka, Indiana 47666
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YFS NO CONDITION YES NO CONDITION
❑✓ ❑ 1. Will this property be the buyer's primary
❑✓ ❑ 3. Homestead
residence? Provide complete address of primary
❑ ❑ 4. Solar Energy Heating /Cooling System
residence, including county:
�i
❑ ❑✓ S. Wind Power Device
, c e �����
❑ ❑✓ 6. Hydroelectric Power Device
['�ddress(NumberandStreet)
S c�Ce� Set o. "' k.4 L17(pStL 1.�?��
❑ ❑✓ 7. Geothermal Energy Heating /Cooling Device
-
City, State NP
Code County
❑ ❑ 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 receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructionsfor more information.
Not available in all counties)
Address (Number and Street)
216.04 -a.5 - 30A- »oo.S99 --o,Lo
0% State Z1PCade County
Primary property owner contact name E-mail
SLATE FOR.M!)MIEI WO TRFASum[n RAN 31A
ArrMnfO By.STATE.1151.RD OF.cCra:TC run PtlARIBED BY nit DEPAAfRYt CIF L(R.LL cSWELYMR.T FINANCE IC FI.I-L'JI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead siandani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
® HEA 13+4 2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receisne the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings This information will be kept confidential and can only be accessed by authorized county officials.The fkpanment 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 Property Address
Simpson, Peggy G/Billie D/Loretta
Chapma
200 S MAIN
_ PATOKA IN 47666
158
Peggy G Simpson
P O BOX 355 State Parcel Number Lena! Description
PATOKA IN 47666-0355
�t ltt��ttt�l��rrr��ttt��tt�� IIrr IrIltItlrllt ltritltirtiri
26-04-25-302-000.599-020 HUDSON FARM WEST LOT G
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.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Add ber and street,city,state,and ZIP code) 111 Same as property dress dress
P. . Q, n R �, — \ 96, S: \ (k_r —�.� � a. � t� 424(Qc,
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) U Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
s�
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 eliuible 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
gna .e Telephone
PART 4:ADDITIONAL INFORMATION
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