Homestead_McCoy INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
�D PREPARERIT 1 '''cl'r.7 ' S' , .7-7.7:7-777:777-77T-47'. 7773• -3 t . .= c a ,.l . 41
Steven T Charles Attorney
Preparer of the Sales Disclosure Form - -Tide
417 N Weinbach Ave, Suite 110 Sheets, Charles&Charles
Address(Number and Street) Company
Evansville, IN 47711 812-476-2762 scharlesessheets.com
City,State,and ZIP Code Telephone Number E-mail
WiSELLER(S)%GRA ITORIS)YF 'j. , . ' i",".err-Tt.' 7 �• `-. wit7: 1cr;;.;,1577771
Marsha F Curl
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9969 S Clearview ft
Address(Number and Street) Address(Number and Street)
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ccompletee as re uired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Sig,azure of Seller �+ Signature of Seller
Martha F Curl I/"Q / . 1
Printed Name of Seller Sian Date(M.M/DD/YYYY) Printed Name o(Seller Sian Date(MM/DD/YYM
IMYER(S)%GRi1NTEE(S)L'r1PP IGATIONiF,OREP,ROP.ERT(1`LTAXiDEDUCTdO. 115MFIFeWACL ITiEMS'gklA A is ;
Lawrence R.McCoy Rita F. McCoy
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
/37o Ai Co " EaS W 137o tt1 Co :Pc fsw
Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TAP.
YES NO CONDITION I YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 12 ❑ 3. Homestead F,C
residence? Provide complete address of primary ❑ 12 4.Solar Energy Heatcrili Jing Sys
9! gleq sI a includ in ou _ ❑ 12 5.Windeher 0, e v c
?
06,/ iA a N Str ❑ 0 6. Hydroelettki 1-
/
❑ Q 7.Geothermal EneQtej '^ !.•"" ing Device
City,State ZIPCode County
g Ill 2.Does the buyer have a homestead in Indiana to be ❑ 8 Is this property a resi ef9t5�/intal property?
vacated for this residence? If yes,provide ❑ 12 9.Would you like to receive tax s*ments for this
complete address of residence being vacated, property via e-mail?(Provide contact information
7 including county: below. Please see instructions for more information.
) 3 N (o Ko fl s W Not available in all counties.)
Address(Number and Street)
'gal ZIP yCind, rN 97640 6:bsan alp —/3 :3,5 -.0 v 66, a 99 oar}
County
Primary property owner contact name E-mail
I
y- ? - 'CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1" -.-.'-:+ ',STANDARD/SUPPLEMENTAL DEDUCTION FORM
"It. State Fonn 5473(R15/5-14) HC10
/' Prescribed by the Dew.mem of Local Government Finance
INSTRUCTIONS:See reverse side for fling instructions
NOTE:Telephone,Social Security,driver's license,state identification and federal identifcation numbers am confidential under IC 6-1.1- i .
.7-7: . _ -„:CERTIFICATION STATEMENT]-'°S_ _ - ''777--i:.ir J y';` `-iI
�/ 9 •!Me) �I •(are) the f •• F C i_ certify that I(we)occupied a "- y(o,')• clpal
place of residence or am(are)buying the following described real pro•- ,I nder contract for which a Homestead Property Tax-i-••
Deduction is hereby claimed on the date this application is signed, (date of signature), I(We):
/9 Own. ; ❑ Am(are)buying under recorded contract AY 0 8 20
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualifi perso•j•-sidence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. `"/QS / ' -
_ Os 7:A►.ei
�
If buying on contact Fee Simple manes name
Rearte's oCa where=tract is recorded Rend number 1 Page
s .y', P,ROPERTY,DESCRIP,TION?3Lam, d`.s�°.W'r`s--�.;�' - - °-" ^
Cmq TomutiP 1 Tasy sty O
Parcel eterp'er ' Legal desaion Is the property in carttti
(.., 11Real popeny ❑ Amualy assessed noble home(IC 6-1.1-7)
if any portion of the resleral cvcae or the land not exceeding one(1)acre that 6r neda'tly surrounds cat s:mmae is used to produce income,destine the use and portion
of the property utazed to pmehroe bonne.
074_,5--_ 35- z0q - o6z , z9 .9 - oav
_ ' . - PROPER7YOWNEDELSEWHEREBYCLAIMANT'. i-- °i_•i• ._.
State,County,and ToamNp Is claimant vacating a homestead?
. ' ❑ Yes ❑ No
' I Signature of claimant /1
I hereby certify the above statements are true,correct,and complete. /l/—���
Address of Gonad(numberr�.•ie//a_x arty,gate,and ZIP(code)
41-2"
reed homestead,d any(number and.'ee(yfft e,end ZIP cafe)
9/e • s l.J ��2.c+casJ J/A •- 4 7 7
■
. -.- -. (ASSESSOR USE ONLY) I.= ASSESSED VALUE I HOMESTEAD VALUE -1;.; NON-RES
LIUDE ENTIAL "^'
.
Land not exceeding one(1)acre Immediately '
surrounding residential Improvements 1(1)
Other land ' 1(2)
Total land(line f plus line 2) I(3) _ _ • . - _
Residential Improvements or Dwelling (4) :i` `i '
Annually Assessed Mobile(
-
Manufactured Home Garage (5) - T-....:2-
t2 - :t-a`'• '`:
Other Improvements (6) -" _ -
Total improvements(line 4 through line 6) 1M
Total value (line 3plus line 7) I(6)
I hereby certify the above Is true,correct I Signature of Assessor Date signed(month,day,yaw)
and complete.
Verifying salon 15gnature of Author Date signed(niontth,day,year)
I
r-'=� 2j3,y_—+,:,;; .-:.`isar� -V,MSTANDARD DEDUCTION'A LLOWANCE— -,',ss-y -+`?<Xe�' -ti�-er∎x.
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 64.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-had(112)of the assessed value of the mobile home or manufactured home.
Signaane of •er LQ,O Data signed(mutt day.year)
c 5-8-17
•
DISTRIBUTION:Original ial-Cou Pvd�r,Fie-Steeped Copy-Taxpayer •