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Homestead_Stocker INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D?.1?REP;ARER " `-TT- ,1c.1. r— r t s ;.°r. 'R :r` ;. Y - t -j Roman Ricker Attorney Prepares of the Sales Disclosure Form Title i 219 N. Hart St.;P.O. Box 13 Partenheimer, Kinkle& Ricker Address(Number and Street) Company Princeton, IN 47670 812-386-0050 rrickerehok-law.com City,State,and ZIP Code Telephone Number E-mail !Et:SELLIER(S)/GRAq`T,DR(S) � ... ". =may,= :, _,• ?•. .- ._, <. . 1 Richard 0 Board and Georgia L Board Revocable 1 iving Trust Seller 1-Name as appears on conveyance document Seller 2-Name as appears an conveyance document 825 Hermitage Road 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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". J. rn Lc Signa o Seller Signature of Seller Gina nard Staley Attorney-in-Fact 1/24/2018 Printed Name of Seller Sion Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/DO/YYYy) F4BUYER(SAGRANTEE(S) _A'P,PL eMilON FORWIROPERTtYLTAX DEDU_ST:IONS`IDENIMIFarALI 1IIEMS 11HATiAPPtP,L,,,Y ' -. r• v4 - _Sheir I Stocker 9 ,', p Buyers-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document �f a l� 2033 E.Warrenton Road Address(Number and Street) Address(Number and Street) Haubstadt,IN 47639 JAN 2 ( THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. L'UWV)7:/,A(for- OR ITS NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 512 W Broadway St ❑ ri 5.Wind Power Device Address(Number and Street) ❑ 1Z 6. Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ I71 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 ❑ 17I 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. �1 Not available in all counties.) Address(M1'umber and Street) �;// .- /al-0/- /G g— cv/ 9f -Q�ll Sheila Stocker City,State ZIP Code County Primary property owner contact name E-mail ce CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD/SUPPLEMENTAL DEDUCTION FORM Side Fermi sq](R17/1-19) HC1O Resorted by de Deseronaa or Loral Gwamimu Fiance INSTRUCTIONS:See m erse side for Wing instruchons. NOTE Telephone,Soda)Sepaffg advert Rowse,state idfu l5ca5on and federal lemon rumbas are confidential under IC 6-1.142-37. CERTIFICATION STATEMENT _ '1111 yy//�����1���••��jj--��pp,,,,�T�r��re II Certify 1tHla�/mr+ran)aeATT9emalfry I(roue) :�lf1�). , Ii� _ u�,adJ &SRR'iPCI r N place of residence or am(are)buying the following desnibed real popery under contract for w r til�T,ax Standard Deductbn is hereby claimed on the date thus appGCation is signed, ( too �(7f�g.for trap sfer ❑ Own. ❑ Am(are)buying under recorded contract ay o--_ ❑ Am(are)entitled to money as a tenant-stocdnolder of a cooperative housing corpora te°c'1 ❑ Have a beneficial interest in the trust or the right to occupy the property under the termgp7 uAr ence ❑ Am(are)the shareholder, partner,or member of the entity that owns the property. „uDii.T MAR 12 2018 Remdeh office Were weed u rewrdd Revd msnter Pegs A PROPERTY Ds fl Jg y ,t Canty TOrs'b GIBSO .Tel"i-l• ' •i'C7flY'i&12 - Peas ratter Ladd descWem I is the PNety b sestina ❑Real lrcpaty ❑Annually messed motes Immo(SC 61.1-7) d fry poem d the residential Ouches cede land not a meeCow one(I)acre PM thtnergmy surrounds that sausee is used to pods income,desode ere use aid poles Cl the property wdml to pants borne ; Ice-o '1 - Io3 -coI. g5)-o98 :>i'i.7.7 t.;..AP,ROPERTY-OWNED ELSE WM ERE BY C LA IMA NTT&gs':. _v;` '-°:y „ '$s:4 sate•C01ey Hid Torvdip Is claimant vacating a homestead? ❑ Yes ❑ No • •mse of damsel I hardy certify the above statements are true,correct and complete. S • . ♦_AS • Mitts •• _,of mead(number aa street ofg slim.end ZIPev2) A ASSESSOR USE ONLY � ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL =° ... —I. ..":i'^'VALUE. .: ..? aunound-m bn)provemenb Immediately (1) 'a `y t`yI+t�F¢ ..-, Other land (2) }-- _.tiiY,,M7Mx- cPtd Tote)land(hoof plus line 2) (3) Residential hnpovemrds or Owemng (4) annually assessed mobile l manufactured home Garage (5) .0 Y£ '+rl �`w Other improvements (8) _....,. - :u .. • Total improvements(line 4 through line 6) (7) Total value pine 3 phs line 7) (8) I hereby certify the above Is true,correct, S o saassce Date signed(em1(MX used and complete. Vedfyilg action-Signabre cAUdas Data signed Walk de):Wan • �T=.• �. c _.. �STANDARO OEOUCTiOtJ ALLOWAfJCE`j�,� � - _� :_ 20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000. Not.f hstaridng any oterpodsor the sum of the dedxsora provided in IC 6-1.1-12 to a amble home $ that is not ._.•••.as real property or to a red home that is not assessed as ealpropedy may not exceed. .. ..(V pi the assessed va the mobile home or��mandacda\M home. tX> a►7 r Put) � �C/ DISTRIBUTION:pipe¢/-Carty Aud its,Re-Stamped Copy-Taxpayer f \• 1.4� ���JJJ Page I of 2