Homestead_Turner (2)INbIANA SALES DISCLOSURE FORM SDF ID: F -age 2
D.PREPARER
Preparer a] Sales Disclosure Form
_ ox 13 219 N. Hart St. and
Princeton (Number
IN 47670t)
Cat); Smte, and ZIP Code
E.
Attorney
Title
Hall. Partenheimer & Kinkle
Company
E -mail
The Fctatp of Anita White
,ppeorson 9myty,aci vme Sell r- Nameasappearson mmeyanced nrent
nd tree[) A dress(Nurnber and Street)
Sc >K 317 3e,21 ay.
Code �� ` � Gtf tote, and ZlPCade
E -mail Telephone Nunrhe, 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 b {1 v, is prepared in accordance with IC 1 -5.5, "R/ e l ProTerty Sales Disclosure Act ".
fignn/ure of Seller Signa ureofSeller
1 -Nome as appears an roronce document
Address (Number and Street)
ate, a IN and ZIP Code 47666
THE SALES DISCLOSURE FORM D1AY BE USED TO APPLY FOR CERTAIN DEDUCTIONS
CONDITION
Q ❑ 1. Will this property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
409 S Wood Street
Address (Number and Street)
Patoka IN 47666 Gibson
City, State ZIP Code County
❑ ❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (Number and Street)
Cary, Store ZIP Code County
Buyer 2 - Name as appears on conveyance document
Address (Number and Street)
Ca y, State. and ZIP Code
Tele h
PROPERTY'. IDENTIFYALL OF SB THdT APPLY.
'Es NO CONDITION \)
ZI ❑ 3. Ho
nergy Heating /Cooling System
❑ 0 S. Wind Power Device
❑ ❑✓ 6. Hydroelectric Power Device
❑ ❑✓ 7. Geothermal Energy Heating /Cooling Device
❑ 0 8. Is this property a residential rental property?
❑ ❑✓ 9. Would you like to receive tax statements for this
property via e-mail? (Provide contact information
below. Please see instructions for more information.
,,Not available in all counties.)
r/p
ttRObert C. Turner
E -mail
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 Secur and Drivers License /Other numbers are not necessary if no Homestead Deduction is
beingfijo.)
Printed e.N/DD/1Y»)
Last 5t 5 di of I Driver's State Last 5 Digits a(Social Security Number
License /ID /Other Number
Signature of Buyer2 /Spouse
Printed Legal Nome of Buyer 2 1Spouse
Sign Dale (MM/Do/MT)
Lost 5 digits of Buyer 2 15pouse Driver's State Lost 5 Digits of Social Security
Number License /ID /Other Number
...WI 1¢3M 9'IR]('-tp TESAStRIP.100.4 TS-1.5
•
AMR. al OATS POSRO.OF AC 01 Nit]m nO.0.11 D RI THE OLAR1.tlt4 OF LOCAL(( u srsxi FLW.(tW s-tr-^-!.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... the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for hompand fraud.Homestead fraud causes higher tax bill-for all:therefore,
0 ILEA 1344-2009 requires taxpayers who receive the homestead slandari deduction to serify that they are eligible to recche the
benefit and to pnwidc additional identifying information neecssan to allow county government to baler monitor homestead
filings.Thi information will be kept confidential and can only be accessed by authorized county officials.The Depanmert of
Local Government Finance will use this information to crane rook that will help count,-officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION .
Taxpayer Name Location Address
I$� y Miller, Jeanine/Alan W/Anita White
51 Il � S WOOD 6T
h PATOKA IN 47666
Robert CTumer ppR122012 III�I�II_�II�IIIIIIIDIIII�III�I�IIII QII011_IIIII.I_IIII�II��II�II01�I�11II
409 S Wood St
PATOKA IN 47666 C.I .
State Parcel Number Legal Description
GIBSON COUNTY A��TGR 26-04-25-103-000.430-020 BARNES ENLG 71 PT
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 - •
s I First Middle Last
/?aril,-RT CHRjsToPfhFk T) R /irk
Mailing Address(number and street,city.state.and ZIP code) El Same as property address
Vo Q S- 0J001) S%. P o _ �ot 3- P TOKA-. A , X76 4
Spouse First Middle Last
Mailing Address(Number and street,city.state,and ZIP code) El Same as property address
Social Security Number(last 5 digits) Drile>'s License/State ED Number (las:5 digits) Other(please specify it Part 4 below)
I I I I I I Sue
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 SS',na nature
�-- Date -
1
Snnusc Signature Date Telephone
( )
PART 4:ADDITIONAL INFORMATION . •