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Homestead_Almon (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 I D.PREPARER ' _ - - - - -Lindsay B. Schmitt Attorney-at-Law Preparer of the Sales Disclosure Form Title 20 N.W. Fourth Street.7th Floor, P.O. Box 657 Bamberger, Foreman. Oswald, & Hahn, LLP Address(Number and Street) Company Evansville. IN 47704 (812)425-1591 Ischmitt{ahbamberger.com City,State,and ZIP Code Telephone Number E-mail E.SELLER(SJfGRANTOR(S) --- - - '_ ' ' . Angela F Almon Personal Representative Estate of Roy L Almon Seller I-Name as appears on conveyance document Seller 2-Narne as appears on conveyance document 9151 West State Road 165 Address(Number and Street) Address(Number and Street) Owensville IN 47665 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". Q k&a<-4 (OLnn 0-eh es.p Signatuke of Seller Signature of Seller Angela F Almon Personal Representative F 6/26/2015 Printed Name of Seller Sian Date(M)14/aa/YYYYI Printed Name of Seller ��?? $$ T- -�'''','` �SiwtDate(MM/DD/1nl) F.BUYER(S)/GRANTEE(S) -APPLICATION.FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALIpt3'EIN S"PAT -.I- - __ - KKKKKK kk _t_e ..ti—d A--e- - - - Angela F.Almon ` Buyer I-Nome as appears on conveyance document Buyer 2-Name as appears on conveyance document 9151 West State Road 165 UL 1 2015 Address(Number and Street) Address(Number and Street) Owensville, IN 47665 ' THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL DOOT17rST APP ` N (rt YES NO CONDITION I YES NO CONDITION ,,{{}}..N AA ❑ ❑ 1.Will this property be the buyer's primary I7J ❑ 3. Homestead*Mt'O9 rce ( ,4, a residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/dim/ UU,,l77ng System residence, including county: ❑ n 5.Wind Power vice Address West State Road 165 ��- Address(A'umberandS:ree[) ❑❑ 6. FlydrpesSQrCOUNTY AW1 a�.Rn • Owensville. IN 47665 Gibson 7.Geothermal Energy eatmo i%Device City,State ZIP Code County ❑ Q 2.Does the buyer have a homestead in Indiana to he ❑ 8. Is this property a residential rental property? vacated for this residence? If yes,provide ❑ IA 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) '2( CO I07OD ,Gal l - City,.State ZIP Code County Primary property owner contact name E-mail SLATE FORM!!W IR_/ANI TREASULEA RAN i11,[ \rPRovEO BY CIRCE M41nor.CCOUNTS.Air. PLLACRWW BY Tt1E DEPARTMENT(F LOCAL GOVOLYMENT FINANCE IC 6-I.T-U41 r. Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples are limited to one homestead standanl deduction.As the receipt of this deduction becomes amore beneficial.there is more ineentixe than ever for homestead fraud.homestead fraud causes higher tax bills for all:therefore. Illr HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reeene the benefit and to pnwide additional identifying information necessary to allow county government to better monitor homestead filings_This infornutinn will be kept confidential and can only he accessed by authori,ed county officials.The Department of Local Government Finance will the this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Almon, Roy Lee Hr I Box 42-a Owensville IN 47665 6061 Roy Lee Almon 9151 W SR 165 State Parcel Number Leal Description Owensville IN 47665 26-17-10-100-000.027-021 005-00027-00 PT N NW 14312.614 AC PART 2:TAXPAYER INFORMATION Owner I First Middle // Last ?i of /ee 4 nor✓ fig •Address(number and street,eity/'State,and ZIP codde) - - - I I Same as property address - 9161 CU 5f4 /6S Owe&Sv;LL , J. N, 1-19466 Spouse First Middle Last A�1sLl� F /I L,�o � , Mailing Address(Nun and street,city.state.and ZIP code) ❑ Same as property address 9 /51 w 5RI65 Oe+/5vl'ae1 I N. ([2465 Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is elicible 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 nature Date ID FORM HC 10 1979 To Be Fileo in Duplicate Rescribeo By State Board of tax Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �O SEE BACK FOR FILING INSTRUCTIONS (We) - l�n r — certify that on the 1st day of March, 19 0_, I, (We) occupied as our rincipal place of residence the following described real property for which a Homestead Property Tax Credit is hereby being claimed: I, (We) 13 owned ❑ are buying under contract ❑ have a beneficial interest in the taxpayer Property Description Taxing District (City, Town, Townshiol: Parcel Number If buying on contract: Owners nam OoS+cvook , my '/2ayt.14�cryv�eivA Township or legal description shown on tax statement: /U a. /U W —;e / O — 3--/ , to /`/ACS Contract recorded in Recorders Office - Record No If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income Any other counties in which individual owns or is buying real property: County Township certify the above statement is true, correct and complete (,N\ n /1 o o, ana Zip cone Individual either owns or is buying under a contract that provides he is to pay the property taxes on the residence, or has a beneficial interest in the taxpayer. - FOR ASSESSOR'S USE ONLY - Land not exceeding 1 (one) acre immediately surrounding residential improvements Other La7 �� Tota r�' ME1 Rest ntialaal Improve '60 Dwelling IAN( 7 1��� � Garage Total Other4npj- emeri1y�11�n T ' ' Improvements - Line (6) plus (7) equals (8) OIby certify the above is true. correct. and complete. AsS ssor Appro True Cash Value (1) So 0 (2) — (3) $o O ( , 4) a.O O (5) G-=C —Q---0 (6) o a o (7) — O — - ACTION BY AUDITOR - Assessed Homestead Valuation Valuation S -io- 8'o Date