Homestead_Sorg STATE FORM 53569(8315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.IJ3-8.1
LIMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•,causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PAR I: PROPER Y INFORMA ION
Tacpaver Name Property Address Slate Parcel Number Leal Description:
Michael T Sorg 1529 E 1200 S 26-23-16-100-002.009-024 PT NW 16 4 10 3.908 AC
HAUBSTADT IN 47639
Complete and return to: !®IIQQEQQEm O1mm111I®111ID111 I0 WM
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION
Owner 1 'nr 1 First Middle Last
III�64M tkcwnas So J
Mailing Address(number and steel city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits)) State Other(please specify in Part 4 below)
att4 0 3 - i 3 sa LI Li 0 IN
aPwse First Middle Last
Ma R Sow
Mailing Address(ran . and sheet city,state and ZIP code)
X] Same as property address
Social Security Number(last 5 digits) Driven License/State ID Number(last 5 digits) stale Other(please specify in Part 4 below)
PART 3: CERTIFICATION •
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date Telephone
I a r C7Z14/I1—
/ Date Telepbc e
y��� a� � (gIa ) 76?4 Yy
:PART 4: ADDITIONAL INFORMATION
_i• F I L R I JLJ
AUG 242012
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GIBSON COUNTY AUDITOR
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��� INDIA\A S.\LES DISCLOSURE PORJI SDF ID 26-2009-7000382 � paee �
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CRISTA WALLACE NPIST
Pre�wro fihrSale.aDi�rlruurrFoim Tide
605 S. E. MARTIN LUTHER KING JR. BLVD. .�O.S(�1W88�@fTl (f1C18l18 L3I1d TItW IIIC
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JIMMY J. MARTIN
Sr//er -.\'amr as aprprars m�r�mvcam�e Jorumrn:
5703 S. 775 W
Adl.rxr �Abmhn wd Jrrrrp
OWENSVILLE, IN 47665
Jnder penalties otperjun�, I herebr cer�ify that this Sales Disclosure, ro the bes� of my knoaledge and belief, is true, correct and
�omplete as required br la�v, and is prepared in accordance �rith IC 6-I.1-i.�, "Reul Properh� Sales Disclosure Act".
� �.�� � �ca,�G,ri. G�-.1��s. �dsa�,� ��uH�o� .�. �v1�..� 1�,�,,k.s. /��n,.ti
Si.nnru.rn Irrr V signunvru)Allrr
Jinmy J. Martin by Sherri S. Hudson, AIF Channon D. Martin by Sherri S. Hudson, AIF
P.inrrJ�'omroj5ellrr Q�.�Q�n� SirnOnm(.N.4l�DDO')�Yf) AinrrA.�'�m�rofShce� Q�.�QY�d)nte�4l.11iDDiT'1'i97
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T. SORG
. op�rar.� m romrrnn�e ✓a�mmnt
.529 E 1200 S
dJdrrrf (}'nmberunJStrcrfl
HAUBSTADT.IN47639
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1 DES'fl F\' ,U,I, OF TNOSE THAT
r i. Homestead
. " . rey ea:ine/Cooline Spsrem
r i. \Vind Poa�er Devicc
r 6. Hydroelec[ric Pow�er Device
r 7. Geothermal Enercy liea;ing/Cooline Devim
r 2. Does the buvcr ha��e a homestead m be vaca�ed for [his residence? 11 r g, Is this propem� a residei�eial ren[al propem'?
}•rs, provide complere address of re<idence vacatine, includine county:
j— 9. �S�oulA you like t0 recieve �as sm[emen.s !or this prop\e .�ia
e-mail? ("Pruc(dr ronm � -• � . . .
12060 S 50 W ..- � mns, oi' more ii fmvnmian. :Vut nvailah/e in nll ��ounrie�'.)
ada.��, �:m,mnr. ��d sn.0
HAUBSTADT, IN 47639 GiDSOn � —' b— �" O _Q '1
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Cin�.Srair.anJZ/PCMr cn�mn� Primun�pmp•m�oMm�.eomm�nu, E-ma.(
�nder pena ues of per�ury�, 1 here y ceruf�� [ al lhis a es isclosure, lo ihe es� o mc �no��ledpe an belieL �ti irue, correct and cump ete as
required bp law, and is prepared in accordance ���ith IC 6-I.1-5.�, "Kral Properic Sales Disclosure Act". (\u[e: Spuuse Information, Social Securitr
and Drirer's License/o�her numbers �re nut necessan� ifI no HIumes[ead Deduction is Aeing filed.)
7Y1, c��.(' � Sac� �]. . 5��.�; S.�fl�i,csn. {lzr� -T�iau� /1-S�-ca G�f'�� Sl�,d,d.m..,.,¢�F
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