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INDIANA SALES DISCLOSURE FORM SDF ID 26 -2009- 1000432 agd` t
ID. PREPARER'
SAMANTHA CUTSINGER BROADWAY TITLE, INC.
Pr r,surerofde Sala tlisrlasvre Form
226 W. BROADWAY
Adders (•Number and Sncey
PRINCETON, IN 47670
Cm, Smfe. a and 7JP Cade
role
BROADWAY TITLE, INC.
Company
(
Te/ephom,Number E -mail
JE:SELLER(S)1GRANTOR(S)-
JAMES RAY SMITH
Seller -Name as oppea.s on emivevc xe daevmew
112 S. MAIN ST.
Adu,,ess (xamber and9rcea
PATOKA. IN 47666
NA
Telephane:Vumber
E -mail
SARAH C SMITH
Seler -,Nome as aypraa on mnvewmcr davmem
112 S. MAIN ST.
Address byumbe,,m S ,ead
PATOKA, IN 47666
E -mai!
penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and
to as required by law, and is prepared in accordance with IC 6- 1.1 -5.5. "Real Property Sales Disclosure Act ".
1 � � n � n M
BRENDAM Windorski
Buver -Nam, as appears on mmvymxe dovnxm
_80*A CEVANS STREET
PRINCETON, IN 47670
City, su;w,
E -mai
SALES DISCLOSURE FORM
r- 1. Will this property be the buyers primary residence? Provide complete
address of primary residence, including county:
112 S. MAIN ST.
Address ((umber and 5aeef/
PATOKA, IN 47666 Gibson
City. Sm:r, and LP Cole County
r 2. Does the buyer have a homestead to be vacated for this residence? I f
yes- provide complete address of residence vacating, including county:
Address (Number and Ssrea)
Ci9..Ra... and LP Code Cmmn•
AND CREDITS'- - IDENTIFY'ALLIT.EMS TH. T APPLY
TEDDY A CHAPMAN
Baver -,some as appears
Address (Number and SIreef,
PRINCETON, IN 47670
Cin'. Siam and LP Cade
T,J, cd
FDUCriONS FOR TIIIS PROPERTY. IDENTIFY ALL OF THOSE TRAT
F.- 3. Homestead
F- 4. Solar Energy Heating!Cooling System
r 5. Wind Power Device
r 6. Hydroelectric Power Device
r 7. Geothermal Energy Hcating /Cooling Device
F7 8. Is this property a residential rental property?
r 9. Would you like to recieve tax statements for this property via
e -mail? (Provide comact information below,. Please see the
instmenors jar more information. Nor available in all counties.)
10 7--ate -�1.
pmprrt owner, somas, name
ties of perjury. 1 neren\' cerllty triat tats Jllles oisclosure, to me nest 01 my Knomeage ana Denel. Is true- correct anu complete as
law. and is prepared in accordance with IC 6- LI -S.i, "Real Property Sales Disclosure Act ". (Note: Spouse Information. Social Security
Lice other Al sobers are not necejsary if no Homestead Deduction is being fled.) r
n / /- /
.Name
_ii
. 0
STATE FORM MO ERJ/i10) - IAEA SERER FORS TSIA
APPROVED BY STATE BOARD OF AMOUNTS apt PRESCRIBE)BY M.DEPARTMENT OF LOCAL GOVERNMENT MANCE IC 6.I.I-214.1
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,
lip FILED HEA 1344-2009 and p ovide additional taxpayers i afro ng in the homestead ece standard a y to allow deduction to brier that they are eligible monitor homestead
the
1 benefit and to prmide additional idenufiing information necessary to Bllaw county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The I}paranent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
APR 2 5 2011 •.
— Taxpayer Name Location Address --
C- :� Windorski, Brenda M/Teddy A
Chapman - 112 S Main
GIBSON COUNTY AUDITOR: Patoka IN 47666
108 I II
Brenda M Windorski I II_I�III_�II�II II III�II I_DIII _I�II_I�I�II�II_II_Ill�llII I II_�II�IIDI�IdII]III
112S Main St
PATOKA IN 47666-9520
"'III1I'1111II11I1ItI'II"'I'IIII'll'III11IIII'1I11II"IIII1I1I1 State Parcel Number Legal Description
26-04-25-102-000253-020/PT NW 25 1 11 1.420 AC
i
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 1NFOR:MMATION
First - Middle Last
P OrA i
Mailing Address(number and street,ci tate,and ZIP code) - ❑ Same as property ad s e
III (c
Other(please specify in Part 4 below)
Spouse First a .Middle Last
T-PAri 1/ ' /� I belt haTO 0 fl.
•MiiimgA'rdress( umber andsrreeC iiy.statc,and Z1Pcodc)—'- — - _____c case perry address—
. - 177"x'^^'
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