Homestead_Holder spit FORM!)!r+IIL'i Yrl 1CL4AIEn MAN SIA
,PPRCFEt BYMSTE 004./CD OFMYn1,NrS.'Or A.EYTIBEW BY TIE DEPARTMENT OF LOCAL covr st.Nmna FINANCE MH.I-2:4I
Gibson County Auditor
• 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
A vs more beneficial.there is more incentive than on for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1314-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necsary to allow county govemment to better monitor homestead
filiru s.This information will Ise kept confidential and can only he accessed by authorized county officials.The Delanntent of
Local Government Finance will use this infomation to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Property Address
Holder,William Keith/CI>asiuy.
HI
Oakland City IN 47660
1827
William K Holder
7900E 300 S State Parcel Number Legal Description
OAKLAND CITY IN 47660-8510
26-13-28-100-001.545-004 002-01545-00 PT E NW 28-2-9.56 AC
III..lI...1.Iltrrllrellt11Ir11111111111111I11111.,,II IIEI C-1 0-6
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
I /& I L j4 Id-e r-
opAddress(number and street.city,state,and ZIP code) [ lame as property address
� 9ozE bS O(4 kcANO C I•l ylut,a
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
__ -- . sa
- - -
-
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 I Signature Date
.7
7
I;;DIANA SALES DISCLOSURE FORM SDF ID; Page 2
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PREPARER
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Preparer ofthe Sala Disclosure Form Title
Addr.(N dS& 1) Company
"fffK. FiTLE SERVICES
P I E-mail
Citl, Scam pndmv. rUUtj I H ST. STE 500
EMANSVILLE. IN 4776A�
E.SELLER(S)/ GRANTORS ).�--'�---�-.-2-�--�":", FT,
lL—I I ff/W RLYk-
S —appears an conveyance document
Na
Seller 2- Name as appears a camueyanc, document
79or) E ko 5
Address (Number and Street)
Address (Number and Strew)
6A0
6)AQRJ--D 01Q /Af V7
E -mail
Tele,hana Number Email
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".
Signature ofSeller Signature of Seller
�� 7fl 0 A7 I)cp--
Z2�
fSeller /YYYY) Printed No., of Seller Sian Date NM/DOIYYM
F. BUYER CS)/ GRANTEE (S) =-APPLICATION FOR DEDUCTIONS UCTIONS AND-CRE61TS 7—'IDENTIFY ALL ITEMS THAT-APPLY
G o A/c/M
Buyer 1 -Name as appears an conveyance document
Buyer 2 - Name as oppeari, an conveyance document
1 3L L
AR(N,,;� and Sa-cnt)
Address (Number and SWc,r)
DAelavf) C177 11V 7(-�O
E -mail
I Telephone Number E-mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES KO CONDRION'
U/ ❑ 1. Will this property be the buyer's primary
(D' ❑ 3. Homestead
residence? Provide complete address of primary
❑ Q' 4, Solar Energy Heating/Cooling System
rest. including county:
E.res
,
5. Wind Power Device
6. Hydroelectric Power Device
a d �Vcct)
CM1 /A/
7. Geothermal Energy Heating/Cooling Device
❑ 8. Is this property a residential rental property?
City, State ZIP Code t County
E] ED,/ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide complete address of
residence vacating, including county:
Add ss(N..be,.adStcct)
Cn,,,Swu,ZIPCode
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
. by law, is in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
and complete as reqtp red and prepared
rarcafBayerl Sigrustone of B.y,,2
!;7 0
ea 7V /-OW4 5 09
a Printed Name of BM, 2 Sian Date (MMIDDIYYM
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