Homestead_Whitehouse(I
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
^'PREPARER:`
NA HARPER CLOSER
Preparerofthe Sales Disclosure Form Title
19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES LLC
Address (Number and Street) Company
EVANSVILLE IN 47708
E -mail
E. SELLER GRANTORS _ ,':.,r _ ';. C.
CARI A AY F ARS NNA CAR LA AY ODY
Seller 1 - Name as appears on conveynnre document
Seller2 - Name as appears an conveyance document
104 t\I. mdill reo+
(Nun and Street)
Address (Number and Street)
'�%Qdresjs /beer
L.�.
i�
City, Stare, and ZIP Cade
Ciry, Stare, and ZIP Code
E -mail
Telephone Number 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, anJd is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act".
�LQ.CA
nl aock Yl .
naarre of5eller Signature ofSeller
( 1C2 _0(4_c9
K. Ud i
Print er Si i Mb /DD Printed Name o Seller Sian Date MM /DD/YYYYI
' .6UYER S G NTEE(S)_=APKI CATIONT ORP. ROPERTY• TAXDEDUCTIONS= IDENTIEYAGLFITEMSTHATAPPLY,. -` —_
BRANDON D. WHITEHEAD
Buyerl - Name as up rson conveyanred en[
Buyer 2- Name as appears on conveyance document
r4. 1:1)mnCh
and Sret)
1N i-O Io,4�
s2(Xumber
Ad 5treet)
E -mail
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TH ERTY. IDENTIFY ALL OSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
❑ 1. Will this property be the buyer's primary
❑ 3. Homestea
residence? Provide complete address of pr a
nergy Heating /Cooling System
reside ce, in udin coun
}�`ia I �i ����
❑ S. Wind Power Device '
❑ 6. Hydroelectric Power Device
¢dp� xa,�nerr1dS ,1��
/�i �� ^�
�)�
Y KK 4
l ✓.Jl.
❑ J. 7. Geothermal Energy Heating /Cooling Device
F�I�
❑ ,.{L�a� 8. Is this property a residential rental property?
E] L 9• Would like for
CIry, S` te�Z Cade County
❑ I b 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
tL you to receive tax statements this
/7"
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not availab a in all cou ties.) /�,,%D
�%/ /1 � �I — .e{� �, / (f(/
QCO t/ w
Address (Number and Street)
Ciry State ZIPCode County
Primary property owner ronratt name E -mail
nu
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.)
.
nature of Buyerl Signature ofBUyer2 /Spouse
� I I - z'i oy
u�Q ndoll . l">J111�e Ili (c cl
Printed Legal Name of Bayer l Sign Date (MH /bD/YYY11 Pnnted Legal Name ofBuyer2 /5pouse S(gn Date(ftM/DD/1YYY)
Fri
�
Last 5 digits of Buyer l Driver's State Last S Digits of5ocial Security Number Lost 5 digiu ofBuyer2 /Spouse Driver's State Last 5 Digits of5xial5ecunry
License /ID /Other Number Number License /ID10ther Number
STATE FORM 53564(P318-1a) TRE\SCa n FORM 13-IA
APPROVED BY STATE BOARD OF ACCOUNIS.2%9 • PRESCRIBID BY THE DEPARFME\-r OF LOCAL GOVEAYMEYr FC1AK1 IC 6-1.1-:34.1
' Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAI) PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to-one homestead standard deduction. As the receiyt 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.1344-2 009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
/ , n . benefit and to provide additional identifying information necessary to allow county government to better monitor homestead'
,, gS filings.This information will tie kept confidential and can only be accessed by authorized county officials.The Department of
F I � R j:_ , Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFOR:MAT-ION
APR 1 8 ?f 1I Taxpayer Name Location Address
C Whitehouse, Brandon D
104 N MAIN
GIBSON COUNTY AUDITOR, PATOKA IN 47666
76
Brandon D Whitehead 11111 iii111m1 11101111111 0111111111011111.11_11111111111113011]IIDl:11tiliii
104 N Main St.
PATOKA IN 47666
State Parcel Number Legal Description
26-04-24-304-000.115-020/GOL DIV 47PT/48PT/73PT
5
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
Ov..._. I First ,, Middle Last
kAil1,� 412/ �i7t t . ,
Mailing Address(number and street,city,state,and ZIP code) Same as property address
liz/ Al A4A•;12 - •
is.
Spouse /2//f First Middle Last
Mailing Address(Number and street,city,state,ancIZIP wdc) - _ — - —D Same as property address - —_'
•
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Past 4 below)
- I I I I ''I , 1 I -I I SM,e
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 1 "gnature Date
,
410:Signauue Date Telephone r
\ )
. r
PART 4: ADDITIONAL INFORMATION