Homestead_Stafford (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
_IXPREPARER.-.
Becky King Closing Services
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd., Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 812-759-5555 becky.kinq(o)regionaltitlellc.com
City,State,and ZIP Code Telephone Number E-mail
I E 1S E L B E RI T G RA N T O R(S)
Ronald J. Roy -- -
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1897 F Warrenton Road
Address(Number and Street) Address(Number and Street)
HaubstadL IN 47639
Under penalties of perjury,I hereby c• tify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and com, A- a e e by law . • s prepar•d-in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
(Signamr�e of Seller Signature of Seller
Ronald J Roy 02/17/2017
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller Sion Date(MM/aa/YYYY)
,F..'BUYER(S)%GRANTEE(S), APPEICATION FOR:PROPERTY TAX.DEDUCTIONS- DENTIEYcALLITEMS THAT APPLY: .-
ByrI- Stafford FneLED
Buye r7-Nameas appears on conveyance document Buyer 2-Name as appears on conveyance e
605 N Gibson St.,Apt. 1
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 FEB 21 2017
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OFTHOG:IBEQNFGOUNTY AUDITOR
YES NO CONDITION I YES NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 151 4.Solar Energy Heating/Cooling System
residence,includin g coun ❑
604 W McCarty Rd h' S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Princeton. IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ al 2.Does the buyer have a homestead in Indiana to be n 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide n Fl 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) (\<�— 12—18403 —pot.c2 ,9 t?$
City,State ZIP Code County h.[/
Primary property owner contact name E-mail
,s- - CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
Slap Form 5473(R15 1514) HC10
Mill
Prescrited by the Depalment of Local Govc.^..iera Fenn
INSTRUCTIONS:See reverse side for fang instructions. - .
NOTE:Telephone,Social Security,drivels license,slate identification and federal identification numbers are confidential under IC 6-1.1-12-37.
.. s:-T c..h i ...CERTIFICATIONSTATEMENT ,.- .'.,'.. r.:.`..I ''-Z'S.l:'
I(We) en Q.- .!�7,i JAW" certify that I(we)occupied as my(our)p l
place of residence or am(are)buyin•A i following described real property under contract for which a Homestea Property Tax Sta r
uCJon is hereby claimed on the date this appfira'don is signed, (date of s�iQ �). '-):
Own. ❑ Am(are)buying under recorded contract Sr�o' �I�
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. OG 'ja
Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residen4' "'S�'
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. i
If buying on contact Fee Simile owners name
Reaxdets anus where ax pad is r yW Remit number (Page
'S t1Q3ii`gals'I.s�.a?: .arnPROPERT';DESCRIP-P.Ji, LT
covey s,(city,Town,township)
rL i .
P arcel comber Legal desoiaion Is the ray in question
/ O -'s,_JL[/a•esi�/ Real P poe•'y ❑AnnuaN assessed rnodh home(IC 61.r-T)
If art porion of the residvcal sauce or the land root�A- -me(I)ace Wtjr.. Uat uuc e is used to produce ixame.aesnbe the use and portion
property tithed to acid• bone- /pJ
16-102/1/03-60/age-a??2
PROPERTY OWNED ELSEWHERE BY CLAIMANT , , - . _
Staw Cc°=y.and Tawutvp Is claimant vacating a homestead?
❑ Yes ❑ No
rebf
I hereby certify the above statements are We,correct,and complete.
Address of=Pat(number end--,, city-ate ZIP code) vacated 13 any(numMr thew. and ZIP code)
/�.. u., ir , ill i1 in Pi} �f762�Y
ASSESSOR USE ONLY' „ASSESSED VALUE HOMESTEAD VALUE ,I . NON-REALSIDENTIAL' t-'4
Land not exceeding one(1)acre Immediately (1)
_-- ".7 -.
. surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3) . . -
Residential Improvements or Dwelling I(4)
Annually Assessed Mobile/
Manufactured Home Garage I(5) - I ' _.. ->r`r;
Other improvements 1(6)
Total Improvements(line 4 through line 6) 1(7)
Total value (line 3 plus line 7) I(8)
I hereby certify the above Is t rue,correct tun d Assessor Date signed(rmvA dal'yea)
and complete.
Verdyitg a=im•Sgnamre of Aw`.mr Data signed(month.day.year)
e"^'' -` STANDARO_DEDUCTION•ALLOWANCE R"'--
20 pay 20 Lesser of 60%of the assessed veue of the homestead or$45,000
NotwYSSandmg any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5 .
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceed one-hall(I/?)of the assessed value of the motile home or manufacrred home.
Signature of AUdtor Data signed(month,day.year)
DISTRIBUTION:Orgnal•Couny Au"_da,Fie-Samped Copy-Tas ayer