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f, -.LES DISCLOSURE FORM SDF ID: __ _ _
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Stacy Brown 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 closinast? regionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
E___ _ _. .. „' ,- I
Lori Ann Connor
Seller]-Name as a rs on conveyance data [ Seller 1-Name as appears on conveyance document
Addr ss , umber ndS eet) ,.///%��t/
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete s required by law,
and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signora o/ eller Signature of Seller
Lori Ann Connor //�-/8
Printed Atom at5eller Sign Date(MM/OD/Yrrrl Printed Name of Seller Sign Date(MM/D p D/YYY
Ei UltBR(S'N..GRA TEE(S1L,ABPLIGWGi\TEORWP.ROPERTVLTAX EDUCTIONS' iIDENTIFYi1LLraTliIt!L
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Tyler M.Connor
Buyer l-Name asap conveyance document Buyer 2-Name as appears on conveys
Ic Dr.
Address(Number and Street) Address(Number and Street) NOV 2 9 2018
Haubstadt, IN 47639
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THE SALE DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P ERTY. IDENTIFY ALL OF THOSE THAT PPLY.
/Ji.CONDITIONCONDITION Will this property be the buyer's primary �Q 3. Homestead
residence? Provide complete address of primary 0 nergy Heating/Cooling System
residence,including county:
5.Wind Power Device
2373 E Classic Dr Address(Number and Street) a 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ a 7. Geothermal Energy Heating/Cooling Device
City,State ZIP ode county ❑ 42Z8.Is this property a residential rental property?
2.Does the buyer have a homestead in Indiana to be a 9.Would you like to receive tax statements for this
i vacated for this residence? If yes,provide
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below. Please see instructions for more information.
-(/'•��I Not available in all counties.)
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Address(Number and Street) ab-a 3-[b _dot) -` c_ • (- 2 ?-/ /aLI
City,State ZIP Code County Priimaaryproperty owner contact name ! v E-mail
,!-W+ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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tea. STANDARD J SUPPLEMENTAL DEDUCTION FORM
Sofa Form 5473(RI7/1-16) HOW
Prescribed by the Denatured lose Government Promo
INSTRUCTIONS:See reverse side for Ping iaWdmns
NOTE Telephone,Social SecuPty divers rlcense,state iclwfdcaSon and&dereide ca6an numbers are wnbleCal under IC 6-1.1-12-37.
CERTIFICATION STATEMENT� w T '-
I(ftle) a I - .. ._ .e. L irtl.+[ til-/ �I��'� " Certify that l(we) -`)L�! 'li')W�Llf.=.wl
place of or am(are)buying the , •1 described real property under contract for which a Homestead Property ax-4Fr'i:C
Deduction is hereby claimed on the date this application is signed, (date Of S�llauJIU) �(V✓e�.1
❑ Own ❑ Am(are)buying under recorded contract A ' 1 Z
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust cr the right to occupy the property under the terms of a qualified pQSenal res" en
❑ Am(are) the shareholder, partner, or member of the entity that owns the property. •
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CcntD' Tatp (r3Y;btvm laaalip)
Pam nmiler legal desvptan Is the proppJerttyyma egnuvstiwc
�i�-0 7 fro- '0l E , .f '/x ❑' %assessed mobile tare(IC 61.1-7)
II any pare=d the rratlal tiara laid eareedeg me(1)tae bon imr.e e:y snoards -amain tnused to Reduce income,chaos Sw use and portion
doe property Maimed m produce item
26 - 23 -( - 2co -ooa- . (v 77 — o — Y
■ k.-: im. .. ::PROPERTY_OWNEDELSENHERE BYYD EA1h7A NT,- , `[r F.
State Canty,and Township Is dalmant vacating a homestead?
❑YYees0No
1 I1Pf2by certify the aim StatMtPf115 are cede,correct,and ncnplEte. X �j
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7
.-.--at mNau mmtG,ard.... agt+ra,'a.endzfP..._ ��% vacatedtwnaamd,aam(mmYwamateet dry Slid,oral zip
ahoE)
I J. -i/-. i
' ASSESSOR USE ONLY s l ' ASSESSED VALUE; ' HOMESTEAD VALUE;__ I h0.!VALIDEUTIAL"_ '
Land not exceeding one(t)acre Immediately� >.sf
I surrounding residential brttuoyetnenb (1) ws F t -%.-T.(2)
Other land
Total land(line 1 plus line 2) (3)
Residential improvements or Magna (4) s 1P i
.il
annually as sessed
mobile!
a
martu(Mnred(tome Garage (Si . .��»....r-.t _.. _.
Other Improvements (6) C -.--sC i ) n
Total improvements(life 4 through line 6) (7)
Total value (line 3 pits This 7) (e)
I hereby certify the above is true,correct, S+i➢taata of Assessor signed(nn do:Yam)
and complete.
VeoyYg aMi-Signature of Auden Date signed(monA dux Ye)
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20_pay 20 Lesser of 60%of the assessed vane of the homestead or$450400.
NoMivumngt g any ofrerpmNSion,the sum of the deductions provider!N IC 6-1.1-12 to a rrotae home S
that is not assessed as real properly or to a manufactured Maid that is not assessed as raalproperty nay
not exceed one-hat(1/4 of the assessed value of the=Me home or manufactured home.
Strtere rePUdbr Data signed(ma dry Yea/06'mI5l ION:Original-Camp Asa Copy-Tapes
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