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Preparer ofthe-Sales Disclosure Form Title
Sherri Hudson Settlement Agent
CeMPellY. Erna 11 Address
Address(number andstreot,city,state,country,and ZIP Code
2301 N.Burkhardt Road,Evansville,IN 47715
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Seller 1.-Name,as it•appears on conveyance document- Seller 2—Name as appears ep ..,nveyance document
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Date signed(tnraddiyyyy)
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'Buyer 1—Name as&appears on tOriveyerige acicUrnent Buyer 2—•Na mess it appears on conveyance document
Kevin J.Welte
Address(number and street) - Address(number and street)"
12434 S.Rosetta Dr
City,State,EiridZIP Code ' ' City,State,and Code
Haubstadt,IN 47639
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. A-. n 1..Will this property:be the buyer's'primary (t '0 3.Homestead •
`-' residence? 0 a. 4.Solar Energy Heating or Cooling System
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STATE FORM 53569(131 BIM TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2C09 PRESCRIBED BYTm!DEPARTMENT"OF LOCAL CAYERNMENTFNAN£ICsI1-tLRi"
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton,IN 47670 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
FIT benefit and to provide additional ept confidential(ning information necessary to allow county government to better monitor homestead
filings.This information will be kept c 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.
PART I: PROPERTY INFOR,MA l ION
APR 11 ?P11 Taxpayer Name Location Address
Welte, Kevin J/Karla J
CJ.n
OFF CR 1250 S
302IBSON COUNTY AUD TOR IIII HAUBSTADT IN 47639•
Kevin J Welte III[III_�III�Ill BillBIDIII�III�I�II_II]III]II_IIII_II�'01I_IIIII_[IllitiIII11111111
4 Rosetta Dr
HAUBSTADT IN 47639 -
State Parcel Number Legal Description
26-23-17-200-001.695024 /BENKERT ESTATES 4 D-9
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tai payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I ���� Fir , Middle Last
K l Sables ?...) R
Mailing Address(number and street,city,state,and ZIP code) ® Same as property address
ay 3y S. 12ost+-t Q br\ 1\&i,. s+od+ ,"IS t-I17(o39
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 I Si .y yam- Date
signeE