Homestead_Laswell •
INDIANA SALES DISCLOSURE FORM SDF ID: - Page 2
D:•.P,REPARER73c' - ' # r•>• _ ��x;' c `1:Mga��"Sc.. .. — r-- 17:er . x.,35 "t• '_.t�:�-�Sell
a. �-�.iz �u� °w'�i.��_.�.:'�,i-... �' _�Ss!: T'L:�sro a y�i�t' -0.S _.ix.3�
KAREN HARBISON VP
Preparer of the Sales Disclosure Form Title
803E STATE•RD 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-768-5800 kharbisoneesbanc.com
City.State,and ZIP Code Telephone Number E-mail
i r;°-_.Z.. __ _. -C. •-�rfr-v^� r s.._.t^F� aa--in .a
,E`SELL'ER(S)/.GRANTOR(S)�e� _�•>s r.: - _^:��•��i.--k3(- '1 — cry '- �i�t- *+_:ss2- . �} 11
. MARCIA YATES I ISA J RATHGFBER
Seller I-Nome as appears on conveyance document Seller 2-Name as appears on conveyance document
5325 E SR 364 4333 HWY 337 NW
Address(Number and Street) Address(Number and Street)
WINS' OW IN 47598 RAMSEY IN 47166
Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn I to as required by law,and is prepared in accordance ' ith1C 6-1.1-5.5,"Real Property Sales Disclosure Act".
l of Ive u (�c�Jr 5 Pr 's
"signature of Ilex ign6 re of Seller
MARCIA YATES 03/17/2017 LISA J RATHGEBER 03/17/2017
Printed Name of Seller Sian Dote(MM/DD/YYri) Printed Name ofSeller Sign Date tMM/DO/YYYY)
EF-.BUYER(S)/.GRAN,TEE(S)TAPP,L'ICATIONIFOR;BROP.ERTr1+TAX;DEDUCTIONSOI DENT(F,YALL'ITEh1SaTHAT-APP.LY7f y
STEVEN K LASWELL I ED
Buyer]-Name as appears on conveyance document Buyer 2-,Yameas appears on conveyance dos t
405W ELM ST
Address(Number and Street) Address(Number and Street) b
HAUBSTADT IN 47639 _ MAR 2 7 2017
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TillS PROPERTY. IDENTIFY ALL OF THO5Ettl ff ' COUNTY AUDITOR
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ 0
2353 S 1250E 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
OAKLAND CITY,in 47660 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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) y' rn-j 4��,�,C�J �/�//�Jt/\) 9 (����t/Q
City,State ZIP Code County - I 1 —1 ` — I `�S/ -`�`-� `-� c� ` I—`� —r
Primary property owner contact name E-mail
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-% i STANDARD/SUPPLEMENTAL DEDUCTION FORM
- ..v . State Form 5473(81515-14) HC1O
r - - Prescribed by the Department of Local Government Finance
n
INSTRUCTIONS:See reverse side/orating instructions.
NOTE:Telephone,Social Security drivers license.state identification and federal identification numbers are ee "I 1-er I- . .:`a'
- _
1!,‘ - _ ?'j.•"..CERTIFICATION S T A T E M E N T!` - 3✓'" 1 3 ' V 1 fy 1 z I }' r
ter
(We) gt a a ce :.-tl .-_ • . my our)pdncipal
place of residence or am(are)buying e Slowing described real property under contract for which a Homestead Property Tax Standard
•• Deduction is hereby claimed on the date this application is signed, M(gt ° igni . I(We):
❑ Own. ❑ Am(are)buying under recorded contract HRR GG
❑ 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 gttL{fig sidence trust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. • NTY AUDITOR
Rewrdels o5ce where contact Es recorded Record number Page
L;97.2 "`iL• =..k-SE`L'irl/H3-3a<N;+? 171-. PROPERTY,DESCRIP,TION _ -n' `x'a`_5 '?ssrlfri v'
County Township Taxing did(dlx ton],to nsfup)
Parcel mother Legal description Is the property in question
❑Real popery ❑Annually assessed medic home(IC 6-1.1-7)
If any potion of the residential stuChae or the land not exceed-op are(1)acre that Inmedaety surrounds that stixtre is used to produce income.describe the use and portion
of the property Mimed to produce more,
a( - I14-I9= /100 -000 . y9f-cz
,PROPERTY OWNED ELSEWHERE BY CLAIMANT_
State,Corey.and Township Is claimant vacating a homestead?
. •,Yes 5 No
y
I hereby certify the above statements are true,correct,and complete. a� ' reedll
Address of mnac(rumba'end-.-- aty,state,and ZIP code) . --of vacated tot.steal,I an umber and sheet,sty,stale,and ZIP code)
s Li .!i1 .1, _ 6 of
ASSESSOR USE ONLY - ASSESSED.VALUE I HOMESTEAD VALUE '.I . , .NON VALDEMwL
Land not exceeding one(1)acre immediately
I(1)
surrounding residential Improvements s u
Other land (2)
Total land(line I plus line 2) (3) _ _____ _
Residential Improvements or Dwelling (4) I 'ltrt •.:a$-A`:
Annually Assessed Mobile I
Manufactured Home Garage (5) } z
Other improvements (5)
Total improvements(line 4 through line 6) (T) I t I
Total value (line 3 plus line T) (8)
I hereby certify the above Is true,correct. Signature otAssessa Due signed(narcl day,year)
and complete.
Vmfyiig action-Sgnatxe of Ahdtor Date signed(moil day,year)
.f: r ?%-, >-`STANDA-DDEDUCTIONALLOWANCECcr -
20 pay 20 I eccer of 60%of the assessed value of the homestead or$45,000
NotwiMCanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
tat is rat assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the aloe of the mobile home or manufactured home.
slphsae 1 R bat 2.+'1 —yI e arl
DISTRIBUTION:Otigihal-County A:dsr.Fio-Samped Copy-Taxpayer