Homestead_Poling INDIANA SALES DISCLOSURE FORM SDF ID: 26 - 17 - 1111391 Page 2
(DP,REP,ARERI, z. —
Jay D.Walden Attorney at Law
Preparer of the Sales Disclosure Form Title
202 E.North Street Law Office of Jay D.Walden
Address(Number and Street) Company
Grayville,IL 62844 618-375-2611 alden
jw @jaywaldenlaw.com
City,State,and ZIP Code Telephone Number E-mail
LE4SELBER(S') GR'ANif(OR(Sj) t - - -- •
Kristy C. Eubanks
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
668 W. Park Avenue
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
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 req'lir•d b law,apd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Se er rrr--}}} Signature of Seller
Kristy L.Eubanks /0_' S.
Printed Nome of Seller Sign Date(aM/oD ) Printed Name of Seller Sign Date(m31/0D/n7Y)
[F::';BU.YER(SY4Gf'ANITEE(SjLAP,PLACATIONM ORMROP,ERTX6TA;YI_1)ERU.KIONSS_IIDENTIIFNALLtiIT ' alit TUAP,P01 -:
Brittany L.Poling
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveya ce do m-
724 1st
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 DEC
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSEOTBATA''L s
YES NO CONDITION YES NO CONDITION HUOITnp
a ❑ 1.Will this property be the buyer's primary ® ❑ 3.Homestead
residence? Provide complete address of primary ❑ ® 4.Solar Energy Heating/Cooling System
residence,including county:
668 W.Park Avenue ❑ ® 5.Wind Power Device
Address(Number and Street) ❑ m 6.Hydroelectric Power Device
Princeton, IN 47670 26 ❑ ® 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El 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 ❑ ® 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) Z4o-ii-13-aoa •ooa ci'f' CioR 7
Brittany L.Poling
City,State ZIP Code County
Primary property owner contact name E-mail
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t".i. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Four 5473(R1T/t-16) HOW
Prescribed by Me Department of Lora Gomm:era Foam
INSTRUCTIONS:See taverns side for grog babucffms
NOTE Telephone,Social Security.diets Ccense,state itlen55ca5on and federal I n mama"�_ Liar • •'t. I
- CERTIFICb1ION STATEMENT
I(We) FIR b n .4 .I. oRdy that I(we)olxauped a rmy(our)Principal
place of residence or am(ate)buying 42-foaming descnbed 4.••- under contract fa wbicA AHptt(�te operty Tax Standard
Deduction is hereby claimed on the•. =this application is sig M FI I� (6 tit-- tgHtire). 1(We):
❑ Own ❑ Am(are)buying trader recorded contract
❑ Am(am)entitled to occupy as a tenant-stockholder of a cooperative housing corpo
❑ Have a beneficial interest in the trust a the right to occupy the property undes�,j��.ee tee�,m nai residence trust
❑ Am (are)the shareholder, partner,or member of the entity that ants the pfd ?ON COUNTY AUDITOR
•
▪arAg CO wtra*Fro Sbpte waste nave
Rmxdeds efts vfwe oodrat is recorded Record nmba Page
PROPERTY DESCRIPTION
Casty ToomshIP Tavp&aril(oh;/own bmsNO)
Prod nnber legal deems Is the p opaty iv question
❑Red pmpaty ❑Annually assessed mottle hum(IC 61.1-0
It any papa of Me roared&encase wee laid not eraetig one(t)acre eat ink strands that ebemae is ate proms income,casaba the use an pores
d the property Wired b pods Income.
— 1- 3 -9,03 - r_a_. • d86o.
.y,?ROPERTYAN/NEDEl5E1VHERE 8Y.ICLAIh1ANTt 9i�.��_
Slate,Cant end Toxaip Is claimant vacating a homestead?
❑ Yes ❑ No
Switze of ailment
I hereby rally the above statue are true,correct and complete.
Address of contact(number end sae*cay,stela,and ZfPSde) Address of rated homestead.deny(number and abed,oby,sr,and ZIPmrb)
ASSESSOR USE ONLY _ ASSESSED VALUE { 1:; -HOMESTEAD VALUE ;7I ' flirt-ESIDENTIAL-`_-_'
Lars rate,residential one(n)-. ants immediately '° ..: -
Lendnotexcding e(1)acre
. rime (t) 1.7 -._
Other land 'Fag:E IG'W.✓ P:at }°
Total land(line 1 plus line A (3)
Residential tmprovemems or Dwelling (4) t
m▪ nufacuredhommobiN1
manute<Strad home Garage (5)
Other Improvements (6) ay"l `�S 175:-rr-i.
Total improvements(fine 4 through line 6) (7)
Total value (line 3 pits fine 7) (8)
1 hereby certify the above as true,correct,
Signature dASSeaspr tiara signed(mrrtq day yaap
and complete.
verifying aaon-S4abre of latent Data sign&(matt my.)ear)
nX�_ - , a7 so . -STANDARD DEDUCTION ALLOVIANCE.e. _. ...rym,c H.._•......_. "' '36> _za
20 .....,, ,pay 20 Lesser of 60%of the assessed vahre of the homestead or$45,000.
NoMPJlstanoog any other pmdsort the scan of the deductions provided in IC 6-1.1-12 to a Amble home $
that is not assessed as real prop ny arty a manufactured have that is not assessed as teal property may
no exceed o ehal( rl of Mc assessed value.. , -mo6de hone or manufactured home.
laWai ►�W—. ,.�. 3 Z► e.
oerml&rnat.Oc)gia- Au cr4 - .<,Cope.Tagela _
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