Homestead_Crooks (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
:±1k.PREPAItERI:;,-- --LT::: :7--rnir-7,07rt::: : ";"• TT TTTTTT Y.
Roman Ricker Attorney
Preporer of the Sales Disclosure Form Title
219 N. Hart St., PD. Box 13 Hall, Partenheimer& Kinkle
Address(Number and Street) Company
Princeton, IN 47670 812-386-0050 rrickerehok-law.com
City,State,and ZIP Code Telephone Number E-mail
(ESETEff itiSitakinOW(Sici:272:- 7:-77 C't r;—Vri
Inn Crooks
Seller I-Name as appears on conveyance document Seller 2-Name as appears on Comuyance document
iloo 1
Address(Number and Street) Address(Number and Street)
One/I•1 K /07
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 re uired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signa re of Seller Signature of Seller
Jon Crooks g if
Printed Name of Seller Sian Date(WA/DD/YYYY) Printed Name of Seller Sian Date(.04/DD/rin)
.,FIUYERMIGRANTEE(S)47XP-PLIGA-TIOKEOWOORERTY13AX,OEDIKtiONS:ThibENTIFVAE— — —A—
Cady R. Crooks
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance ocument
12216 E. 150 S. AUG fg 2016
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PRO• ! . • I HOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 1.Will this property be the buyer's primary El 111 3.Homestea•
residence? Provide complete address of primary 111 El 4.Solar Energy Heating/Cooling System
residence,including county:
n 5.Wind Power Device
12216E 150 S
Address(Number and Street) IA 6.Hydroelectric Power Device
Oakland City. IN 47660 Gibson LI E 7,Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
Ei E II 2.Does the buyer have a homestead in Indiana to be I 8. Is this property a residential rental property?
vacated for this residence? If yes,provide fl (Z 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.
12216 E. 150 S. Not available in all counties.)
Address(Number and Street) 44-47 -OM 53 —OtY0
Oakland City, IN 47660 Gibson Carly R.Crooks -
City,State ZIP Code County
Primary property owner contact name E-mail
%...... v'i., CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R18/1-20) HOW WIA Abc7_72—
Prescribed by the Department of Local Government Finance
NiC).34 INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's '.....4-111ffirermatu Mica i• •-• -deral identification numbers are conhdential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) ihrffo 211111=W o,r) e_
— I_ certify that I(we)occupied as my(our)principal
place of residence v,r a (. e)buying the following described real•roperty der contract for which a Homestead Property Tax Standard
Deduction is hereby c.imed• •- •. - tit....,..--,..; . (date of signature). I(We):
0 Own. El Am(are)buying under recorded contract.
0 Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
11] Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
..\ .•-- El Am (are) the shareholder, partner, or member of the entity that owns the property.
<5) Recorder's office where contract is recorded
Record number .Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcel number Legal descrtptron loll perry in question
..x. 1 Real property 0 Annually assessed mobile home(IC 6-11-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surto do th structure is used to produce income.describe the use and portion
b3 \ • of the property utilized to produce income
'LC---- \ 7 --, 00 - 0 CI SZ a-00
r.- ,-r•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
-\
3 State.County.and Township Is claimant valir g a homestead?
EJ Yes , No
Si lure of claimant
I hereby certify the above statements are true,correct,and complete.
. ....___-_)
Address of contact(number and street,city state.and ZIP code) Address of vacated h stead,4 an (number and street,city state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE i NON-RESIDENTIAL
_k=adeLVAcreeesditarinar improvementsf Immedia"ly (1) ;;.• A:,,r..)..',..',Y,-
Other land (2)
Total land(line I plus line 2) (3)
I.:IL
Residential improvements or Dwelling (4) ,-,''';',.:.'','''::'C',.-.:•1,',:7:';'-ii/''::',:':`,.7,7,,,:',.
annually assessed mobile/ ..
manufactured home Garage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) tfh*Citlaxe a, v 1 I hereby certify the above is true,correct, .4
ts
Signature of A.G -,,
-ar-.•ON COUrvITY A Date signed(month.day.year) ..
and complete.
Verifying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobil aysnufactured home.
Signature of Ary...) Date geed th,day,year)
V"Th.s.S CA_
DISTRIBUTION, Original-County Auditor.File-Stamped Copy-Taxpayer ---21-
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