HomeMy WebLinkAboutHomestead_WarrenINDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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® Preparer ofrhe Soles Dvclosure For Title
r°fOTAI TITLE SERVI ES. LLC
Address (Number and Street) tl 1 N 6 L. STE 500 Company
EVANSVILLE,
IN 47708
City StomandZIPCode Telephane Number E -mail
` -E. SELLERS /G
CHARI FS P BRINER
CATHY J BRINER
Seller1 Name as appears on conveyance document
SetlerZ- Nameasappearsmronve ncedocument
Addr tuber and street) ^
It 1���y lj -/ /[lj
Address (Number and Street)
Ciry• State, anddZ._P Code
I
CRY, State, and ZIP Code
Telephone Number Email
Tele hone Number Email
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 by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
.Signature afSeller Signature of Seller
Printed Name o Seller Sian Date MM 00 Printed Nameo Seller Sign Dow (MMIDDIYYM
T. BUYERS GRANTEE S - ;'APPLICATION FOR PROPERTY,TAX•.DEDUCTIONS2 IDENTIEY•ALL'ITEMS THATAPP.L'Y1
JAMES R. WARREN
SHERIDAN S. WARREN
uyer l - Nameas appears on c nveyan[e dacumen
Buyer 2 - Name asappears on conveyance document
l k �4 /s Sti I�
�S/9ir✓��,
(h'umberan Street)
Stet)
Address (Number and re
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I 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
r ence, includin county:
056, ' C ML Vu . !
c �J /V
❑ S. Wind Power Device
❑ � 6. Hydroelectric Power Device
d ess(Num a nd5treetJ
/��7.
I�tl7 {Ilan IN �7�Li� `- ' /�J��
❑ �7. Geothermal Energy Heating/Cooling Device
❑ Is this property a residential rental property?
CitFState ZIP ado County
❑ F2. Does the buyer have homestead in Indiana to be
a
,�, /$•
❑ LF/ 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide
complete address of residence being vacated,
property via e-mail? (Provide contact information
inclu ing Ou ty: -
11 9 �� I
below. Please see instructionsfor more information.
j _ �'
Not available in all counties.)
c1G -�? -3o -two. oaa.d� aid
dress (NU berandS eet) l
�l �lr�ce�/i /N � IV&) C/ 5el
City, State ZIP Cade loan,
Primary property oumermnmct name E -mail
t�
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STATE FORM OStq(Y0./8-10) TtEASURFA FORM TS-IA
' APPROVED BY STATE BOARD OF ACCOUNTS.aW PRESCRIBED 0Y THE DFP.ARMeEr OF LOCAL GOVERNMENT FINANCE IC AL I-12-&I
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,
HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
�, benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
0
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. o
APR 5 2011
PART 1: PROPERTY INFORMATION
Taxpayer Name Location Address
C' .n V Briner, Charles P/Cathy J
GIBSON COUNTY AUDITOR - 8525 N ACCESS 850 N
. .. HAZELTON IN 47640
10
James R Warren IIDIDIII_VIII110101 DIIII1I1001111LI1011001 H:IIDIDIII IVIIIiIl VIIIIII VIII I II
8525 N Access 850 N
HAZLETON IN 47640-9211
IIIIIIIllIIIIIII'Ilhlllllll'III IIIIIIlIltllllllllIIIIIIllllrIll State Parcel Number Legal Description -
26-02-30-300-002.234-018 f PT LOT 4 301 10 3.203 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.
PART 2: TAXPAYER INFORMATION
First Middle Last 4 ,,-,,,,,,,,,_
-
Mailing Adiiress(number and street,city,crate,and ZIP code)
1C3anfe.as property address -
Spouse ' .. First Middle Last
�IWA
tJ
Mailing Address(Number and street,city,state,and ZIP code) – --— -- -- - – Eramc as propertyaddress-'
A‘.--AS-7) , dead'/ rr e7e 4. ���, 7 $76 el0
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 Signature Date
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