HomeMy WebLinkAboutHomestead_Holland� ��P�3
� INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D. P.REPARER: . � � - � � � � - � � � " • � - �
Dan L. Reeves Attomev
' Preparero(rheSalaDiulosureFOrm Title
716 S. Main St. REEVES 8 COCHREN
Address(NumberandSVeet)
E-mai/
E. SELLER S GRANTOR S' - �
Bonnie PavnP
Seller 1- Name as appeurs on ronveyanre dacvment Seller 2- Name as appears on mm�evanre docvment
a�m s 2so w
Addren (Number and Sveet) Addres (Numbe� and50-eetJ
PL Branch. IN 47Cx1R
Ciry, Sm�e. andZlPCOde Ciry. Smte. and ZIPCade
E-mail Tele honeNUmber E-mail
Under enalties of perjury, 1� e eby cer[ify [hat [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and plete as required w, and is prepared in accordance wi[h IC 641-5.5, "Real Proper[y Sales Disclosure Act".
Signomre of5e/ler Signamre ofSeUer
fiflnnie Pavne � � �Y3 � � �
Pdn[ed,Vameo/Seller Sim re �.a/�D PnnredNameo Selie� SiunDarefMM/OD
F ER 5 G E S-APPLICATION FOR PROPERTY TAX DEDUGTIONS- IDENTIFY ALL tTED15 THAT APPLY
�Aaron C. Holiand
� ameasappeors mnvryanmdxumen[ Buyer2-Nameasaupeorsanconvryanredocument
10
Address(Numberand5tree[J � ,lddrestfNVmberand5tree[J
Ft. Branch. IN 47648
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E-mail iele honeA'umber E-mail
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAI\ DEUUCfiONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TNAT APPLY.
YFS NO CO\DITION I -0 CONDITION
❑J ❑ 1. Will [his property be the buyer's primary ✓ � 3. Homes[ead
residence? Provide comple[e address of primary � � 4. Solar Energy Heating/Cooling System .
residence, induding county:
—109 W John St ❑ ❑✓ 5. Wind Power Device
Address(Numberand5vee[) ❑ 0✓ 6. Hydroelectric Power Device
Fi. Branch. IN 47648 Gibson � Q 7. Geothermal Energy Heating/Cooling Devi�e
Giry.Sm[eZIPCode lounry•
❑ ❑J 2. Does [he buyer have a homestead in Indiana to be � ❑� 8• Is [his proper[y a residential ren[al property?
vaca[ed for [his residence? If yes, provide ❑ ❑✓ 9� Would you 8ke ro receive tae statemen[s For this
complete address of residence being vacated, property via e-mail? (Provide rontoct information
includ ing county: below. Please see instructions for mare in�ormatron.
Q Not a ailable in all caunties.)
Addrets �Nvmber and Svee[f (J� �' ��'" �.�3-4�oa - o 00. 9dS -0�6
Aaron C. Holland
Ciry, Smce ZIPCade Comn�
Rimorv properryoune�mnma[ name E-moil
Under penal[ies of perjury, 1 hereby certify [hat [his Sales Disclosure, to the bes[ of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance wi[h IC 6-11-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduc[ion is
beipg filed.)
A�� l,I!
Signa re o� Bwerl � Signamre of8uyer?/Spauu
�� /j 2� !/
Pn'ntedLegalNameo(Buyrll Sig Date(aw/DO/YY1'Y) Pnn:edLegolNemeo/Buy�er2/Spouse SignDate(MM/oD/YYY1)
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sof5xial5ecuriryA'umber LastSdigi'sofBu}•er2/SpouseDriver's Stnfe Las[SDigitso%SacialSetwiry
License/!D/OtherNumber Number License/lD/OtherNum6er
CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
r.; STANDARD/SUPPLEMENTAL DEDUCTION FORM M
State Form 5473(R15I5.14)
Prescribed by the Department of Local Goverment Finance
INSTRUCTIONS:See reverse side for fling instructions
NOTE:Telephone,Social Security,drivers license,state identification and federal identfnanbn numbers are confidential under IC 6-1.1-12-37.
_ _ - it ,-_CERT1FlCMhON STATEMENT st - _ _ __ �-. {�l ---i
I(We) s ��.� a •arelArI /7�^- certify that l(W:I •c• lied my(•',--fa;Df�y -.)y -
place of residence or am(are)buying the following described real property under contract for which a •°•test-,.•P _
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contact OCT 3 2016
❑ 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 qualified •- •nal residence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. I ai
',.
If bsytrg on contact Fee Simple owner's name _ _ +_
Recorder's o5ce where contact is recorded 1 Record number I Page
Lyt_' -t >=: 7:Cd:OR_'.faroESit `a PROPERTY,DESCRIP.TONt?a' -SSEcrye•rn-lag.7.�s •ts.
County Township ring dvcia(city.tan )
vaoL^ h
-. . .. ••- Legal desaice.ko Is Weeny in question:•-I S- 3 l loci-000.9as-oa eal
popery ❑Av,ualy assessed mottle home QC sLf-n
■
portion resderdel srjCn or the land not exceedae one(1)a at In a a:ey surrounds that cruC-se Is used to produce irw.e,de mist the ae and pw'bn
of the poperty -
1980 3 uLccaneer — o-4 9a1 i -co ( h '''
cl�,/Ybrnsrn
Sate.Casey,and Township Is claimant vacating a homestead?
. . ❑ Yes ❑ No
Sayatura / l
I hereby certify the above statements are true,correct,and complete.
Address dcontad(number and street.sex.cats,and ZIP code) Al of vacated honeseal,it any(number and Cruet cal:Sae,end ZIP code)
e Clef W. all I f B c) .1:4.) N .Ste
• 'ASSESSOR USE ONLY r I • ASSESSED VALUE- r I HOMESTEAD VALUE ,' ; NON-R ASIUENTIAL'
Land not exceeding one(Macre Immediately (11 _ _ Y
surrounding residential improvement _ _ .
Other land (2)
Total land(line 1 plus line 2) (3) _ _ _ — .•
Residential Improvements or Dwelling (4) ~•^-t-'•" ',- -n
Annually Assessed Mobile I Manufactured Home Garage (5) ).•l
Other improvements (6) rre=Ys-o _._
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct. Signature of Assessor Date signed(hearth.day year)
and complete.
Verifying adim-Signature ofAUdtor
:•y`-+- 9fr? .spa.= l ; Da• sig._ I . •\•
ay.year
l ii(I i
£ 5TANDARODEDUCTIONALLOWANCED _
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45,000 rw p•T 3 2016
AbMYhstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home ISI lv
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not exreed`9n. all(1/i)ofthe asses•value of the mobile home or manufactured hone. 4 tai
/ 'TL: iron' de%Yaer)
' IAX)(.,_) GIRSON CO riS Sit
DISTR1aURON: Original-CountyAddp,Fee-Sari-pee Copy-Taxpayer