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Home My WebLink AboutHomestead_Stevens14 INDIANA SALES DISCLOSURE FORM snF In. L, tf— 1 Ray M. Drulev Attorney No. 4759 -26 / Prepare ofthe Sales Disclosure Form Title 105 N. hutch Strut P. Box 14 Law Office of Ray M Drulev Ad dress (Numberaad Saw) Company Fort Branch. IN 47648 ( TiNfliQRr _ Billy D Stevens_ Na Raw Seller 1 - Name as appears on ronvey ince document 104 S West Street Seller 2 - Name as appears on conveyance document Address (Numberad sheet) _ Patoka IN 47fififi Address (Number end Street) City, Stare, and L/P Co)de(� City, Stare, and7JPCode E -mail Tele hone Number Email Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and mpletehas r aired by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act". �� \� SgnatureofSW16 Signature of Seller Billy D, Stevens '7-a• \O Printed Nameo Oate(MMIDDIVYM Printed Nameo Seler Sig, DOW MM o tICAT1. r_ Ols$ILTeX fN{:DEUULPION_S IME{tft!A& 1TIEMSxTTNti_ APPI _ Billy D. S i ame asap non con Buyer l. Name asappears on conveyance doc=ent West Street r Address(Number and Sant) Patoka. IN 47666 City, Stott E -mail Te umber E -mail THE SALES DISCLOSURE FORM MAY BE USEDTOAPPLY FOR CERTAIN DEDULTIONSFO PR FY. IDENTIFY ALL OF THOSE PPLY. YES NO CONDITION 0 COND Q ❑ 1. Will this property be the buyer's prim ste residence? Provide complete addre s of pri /Cooling System tjjE residence, including county: Power Device 104 S. West Street ❑ Q 6. Hydroelectric Power Device Address(Number and Sant) Patoka, IN 47666 Gibson ❑ ✓❑ 7. Geothermal Energy Heating /Cooling Device Ciry• State Z1PCode County ❑ Q 2. Does the buyer have homestead in Indiana be ❑ ❑8. Is this property a residential rental property? a to vacated for this residence? If yes, provide ❑ Q 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.) Address (Number and Street) Gry, State ZIP Code County Primary propertyowner contact name E -mall Under penalties of perjury, l 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.) Signaaneo /Buy'erl Signature o/euyer2/Spouse Panted legal NameafBuyer I S(gn DOW iMM/DD/YYn1 Printed Legal Name of Buyer 2 15pouse Sjga DOW(NM/DD/YYYY) Number Last 5 digits of Buyer 21Spouse Driver's State Last 5 Digits ofsocial Security License/1D /Other Number Number License/ID /Other Number :Is _ STATE RM 5 U0.NiS1A nnavtD BY STATE SQR n Of ACCOUNTS,7.009 PRESCRIBED BY TB nFPVTMESi OF LOULGn4FA‘MEYIT F XAYCE IC 6-1.1-2I2.1 • 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 S 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 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 Stevens, Billy D 104 WEST ST PATOKA IN 47666 1913 • 0,10 II Billy D Stevens 0 mil_ 11 oil0011 l_011l mom l ll�ll ll�lll�ll l l loll 011011.l�lall�ll 104 S West St PATOKA IN 47666-9017 ' 'Illlilltil1l1lilll'Illtltllltillrtilllltlltrltllltll'illli'll State Parcel Number Legal Description 26-04-25-101-000.596-020/ PT Nw 251 11 .402 AC 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. _ f PART 2: TAXPAYER INFORMATION First Middle //y .I�wiel/ I flee/e`/5 tT Mailing Address(number and street,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 See 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 Signature Date Telephone PART 4: ADDITIONAL INFORMATION