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302501 08/31/16
4+y�G4NMf CITY OF CARMEL, INDIANA VENDOR: 371046 s ONE CIVIC SQUARE THOMAS M. CROWLEY REVOCABLE TR(MRCK AMOUNT: $****14,500.00* CARMEL, INDIANA 46032 C/0 MICHAEL ANTRIM,ATTORNEY CHECK NUMBER: 302501 9M,TON_�o 2 N.9TH STREET CHECK DATE: 08/31/16 NOBLESVILLE IN 46061 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 202 4460500 1297561 14,500.00 RIGHTS-OF-WAYS VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) THOMAS M. CROWLEY REVOCABLE TRUST ALLOWED 20 ACCOUNTS PAYABLE VOUCHER C/0 MICHAEL ANTRIM, ATTORNEY IN SUM OF$ CITY OF CARMEL 2 N. 9TH STREET An invoice or bill to be properly itemized must show:kind of service,where performed,dates service NOBLESVILLE, IN 46061 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $14,500.00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Engineering Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 0 44-605.00 $14,500.00 1 hereby certify that the attached invoice(s),or 8/29/16 0 Land Acq for 116th and Hazel Dell $14,500.00 2200 �2 202 2200 202 Roundabout-Parcell bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Monday,August 29,2016 hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Prescribed by Slate Board afAccounts City Form No.201 tRev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL,INDIANA An Invoice or bill to be properly Itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day,number of hours, rate per hour,number of units,price per unit,etc. Payee Thomas M. Crowley Revocable Trust Purchase Order No. c/o Michael Antrim, attorney Terms 2 N.Wh Street,Noblesville,IN 46061 Date Due Invoice Invoice Description Date number or note attached Invalce s or bills Amount DES.NO.: 1297661 PROJECT: 9161h St&Hazel Dell Pkwy, PARCEL: 1 COUNTY: Hamilton Compensation for Permanent Fee Simple) Total: 4 6 0.00 1 hereby certify that the attached Invoice(s), or bill(s), is (are) true and carr an m erials or services itemized thereon for which charge Is made were ordered and received ex ,2016. Signature:Thomas M.Crowley,Trustee of the Thomas M.Crowley Revocable Trust I hereby certify that the attached Invoice(s),or bill(s);is(are)true and correct and i have audited same In accordance with IC 6-11-10-1.6. 2016. Clerk-Treasurer i' i i I VOUCHER NO. WARRANT NO. ALLOWED 2016 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION Board/Cauna11 Marnbom FOR COSTDISTRIBUTION LE06ER CLASSIFICATION IF CLAIM PAID 810TOR VEHICLE HIGHWAY FUND Aat. Acaounl TNa Amount No. EXH BIT" , Project: 1297561 Parcel 1 (Fee Simple) Encumbers Rey No.:29-14-04-000-007.006-018 A part of the Northeast Quarter ofthe Section 4,Township 17 North,Range 4 East,ofthe Second Principal Meridian, in Clay Township,Hamilton County, Indiana and being all that part of the grantors land,lying within the right of way lines depicted an the Right of Way Parcel Flat marked EXHIBIT "B, attached herewith and made a part of this description by reference,described as follows: Commencing at the Northwest Corner of said Quarter Section designated point"504"on said Right of Way Parcel Plat;thence along the West line of thereof South 00 degrees 07 minutes 54 seconds East(basis of bearings is the North line of said Northeast Quarter as shown on a certain Location Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State aforesaid)45.00 feet to the Northeast corner of said grantor;thence along the North line thereof South 89 degrees 33 minutes 32 seconds East 778.72 feet to point "559° as shown on said Right of Way Parcel Plat and the POINT OF BEGINNING; thence continuing along said North line South 89 degrees 33 minutes 32 seconds East 100.40 feet;thence continuing along said North Iine South 83 degrees 56 minutes 07 seconds East 297.28 feet to point "354" as shown on said Right of Way Parcel Plat; thence North 86 degrees 49 minutes 27 seconds West 296.59 feet to point 11560"as shownon said Right of Way Parcel Plat;thence North 89 degrees 33 minutes 32 seconds West 100.00 feet to point 11558" as shown on said Right of Way Parcel Plat;thence North 00 degrees 26 minutes 28 seconds East 14.98 feet to the POINT OF BEGINNING,and containing 0.085 acres,more or less. This description was prepared by DLZ Indiana,LLC for the City of Carmel,Indiana,as part of Project No.1297561 1 on May 19,2015. ti „..0 Alan Brent Cleveland `N\ 11:�' �sT ,,t�`I Registered Land Surveyor,Number LS80880007 No. ! Within the State of IndianaEE $8000 'i 0 *= STATS OF r*`Z: "lanus" �X/ SUR; I I Page 1 of 1. EXHIBIT"A" Project: 1297561 Parcel IA(Fee Simple) Encumbers KeyNo.:29-14-04-000-007.006-018 A part of the Northeast Quarter of Section 4,Township 17 North,Range 4 East, of the.Second Principal Meridian,in Clay Township, Hamilton County, Indiana and being all that part of the grantors land,lying within the right of way lines depicted on the Right of Way Patcel Plat marked BXFMIT"B, attached herewith and made a part of this description by reference, described as follows: Commencing at the Northwest Corner of said Quarter Section designated point"504"on said Right of Way Parcel Plat;thence along the West line of thereof South 00 degrees 07 minutes 54 seconds East(basis of bearings is the North line of said Northeast Quarter as shown.on a certain Location.Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State aforesaid)45.00 feet to the Northeast corner of said grantor; thence along the North line thereof South 89 degrees 33 minutes 32 seconds Lust 879.12 feet to a corner of said grantor;thence continuing along said North line South 83 degrees 56 minutes 07 seconds East 389.26 feet to point 11376" as shown on said Right of Way Parcel PIat and the POINT OF BEGR MNG; thence continuing along said North line South 83 degrees 56 minutes 07 seconds East 67.59 feet to the Northeast corner of said grantor;thence along the East line thereof South 14 degrees 17 minutes 55 seconds East 251.30 feet;thence South 69 degrees 28 minutes 31 seconds West 6.72 feet to point 11603" as shown on said Right of Way Parcel Plat; thence North 17 degrees 42 minutes 49 seconds West 206.91 feet to point"605"as shown on said Right of Way Parcel Plat;thence North 35 degrees 04 minutes 17 seconds West 50.86 feet to point 9606"as shown an said Right of Way Parcel Plat;thence North 65 degrees 07 minutes 56 seconds West 33.95 feet to the POINT OF BEGINNING, and containing 0.099 acres,more or less. This description was prepared by DLZ Indiana,LLC for the City of Carmel,Indiana,as part of Project No.1297561 on February 29,2016. A4^. Alan Brent Cleveland N� Registered Land Surveyor,Number LS80880007 N0. =�Jf Within the State of Indiana S-A 880007 STATE OF *� !No1 AN (:) d SUR;. N Page 1 of 1 EXHIBIT "B„ SHEET 10F2 RIGHT OF WAY PARCEL, PLAT Prepared for to City of Cannel,Indiana 9y DLZ Indiana,LLC(Job No.1463-098240) 352 350 mi 349 710 503 347 a fne^PJ7m� 55Q 559 u„®�• 505 0 Lrne•c 711 354 335 >MPSIreel 3g Lf,a 9 � - � Lfae'F�RC" 45.OD' !f f0'Te%pbaneEase, 504 10'Te/ haaeEa e. 376 334 332 3D'San SesverEese. �`� 606 331 506 I 5D`Umin�geEese.�` — � ��� 35+00 703 558 560 `y 605 a 330 (Res.A) 343 603 701 = i 22. 1 259.3M1 33 +bv 827.3T Al ' l 700 2 zi 0 200 400 eo0 Scale:V--400' G"r17�17g0�1�®917(�©pOddll� Rev(sed RW 2-20-2016 by ABC PARCEL: 1&1A Owners:ThomosM..Crowley,97ustee DRAWN BY: CAD PROJECT: 1707581 fnstfumont Number 200200032971 Dated:04-25-2002 CHECKED BY' HMG 06102-2015 ROAD: Hazel Ild Pkwy GOUNTY: Homlilon SECTION: 4 TOWNSHIP: 17N ENCUMBERS KEY N0. 20.14.84.000.007.008.018 INDIANA, NOE: 4E 157 EAST MARYLAND STREET HATCHED AREA IS THE INDIANAPOLIS,INDIANA 46204 APPfROXIh1ATE PERMANENT RIGHT OF WAY 317 633.4f26 Dimensions s own ere rom thhe above listed record documents. EXHIBIT "B" SHEET 2OF2 RIGHT OF WAY PARCEL PLAT Prepared for to City of Carmel,Indlana By DIZ Indiana,LLC(Job No.1469982.90) Paint Station I offset Northing Wting Point Station 1 Offset Nortbin8 FMOSS line"PR8" Una"PRC° 930 333+38.07 BOOL 1714617.33S9 213997.4087 354 47445.36:P1t74.27R) 17MD3.3BB .2136OU00 331 33616107 DADL 1714928.7451 218906.892¢ S50 40MOO 0.006 1715183.}7'10 21744484,4 932 337409.91 0.00L 1714968,].728 213659.7535 558 43450.00 60.ODR 1715120.5869 7.13212:0123 334 3374*06 (100 L 171506037B0 713974.6454 559 49►50.00.P1145.02 R) 17151a3.S671 2132!2.4276 935 338193.04 0.0D L 1715153.2.690.213M.W4 560 44+50.00" (ADOR 1714119.8172 21330-0093 343 392+27.00 D.00L 1714507.6455 714014.8984 347 47+27.35 QCOL 171517).1.408 213589.8091 376 +P31338+2") 376.70L 1715M601 213899.6103 349 4812A.98 0.00L 1715?79.881B 91e6"aaoa7 936 939184.49 0.00L . 1715249.6988 213SISM74 350 48+7106 O.ODL 17,15180.1600 219888.47]2 338 3414M43 0.00L 1715856.4318 21984&6371 352 48+98.55 0.00L 1715175.3845 213760.6304 940 342481. 87 DAO L 1715526.2613 213785.87$3 506 Seg lacation Control Route Sumoy Plat 603936410:00 110.00 L 1714and618 413812.5924 700 See Locatlon Cptrol Ronte Survey Plat 605 637480.00 115.00L 5715037.7648 213759.6371 701 See laceUonControl RouteSurveyPlat 606 338415.00 145.001. 17156793908 219730A129 710 See location Control Route Survey Plat S03 See Location Central RouteStuveyplat 711 Sad LoentlonContra)Route SurMPlat 504 See Location Central Route Survey Plat 703 See Location Control Routesurvey Plat 505 San Location Control Route SurM Plat • e Curv,DaData Curve Oa P1=3354M20"PRp" P1=47+74.28°PRG" Derta=12.20'16"Lt Delta;9.34'3r Lc Rd5p0.00' R=75W,00' T=16219' T=46.83' 4323.00' tp83.9' 11474' E-02V i pIrgoats CuBw Data P1 43744&62"PRD" P1=48t6ma"PAG 6elta=24'06'19'lt 0ertayl315039 Rt ti�Do,oaar g=3ouaD' r az 7r 7=3e.42' 1=72.47 E 2.2V NOTE: Stations and Offsets Control Over both North&East Coordinates and Bearings&Distances. ����titiillrr�, SURVEYOR STATEMENT ��\\ j' / To the best of my knowledge and belief, this plat, together with the 'l.oaation Control Route Survey Flat ` recorded as Instrument No.2014033M in the Office of � ; NOR� Recorder of Hamilton County,Indiana Inco orated = 1 the R tyr ( rP $$0007; and made a part hereof by reference)comprise a Route *IS STATEO� survey executed In alaordance with Indiana -9 �ND)AN ` Administrative Code 865 IAC 144(Rule 12) r� ��rSU�Rv / . Ct*V4 Febroary 29, 2016 Revised RW 2-29-2010 by ABC PARCEL 1&1A Owners., iom ey,T7usfee DRAWN BY: CAD PROJECT: 1297581 CHECKED BY: NMG 08.02.2015 ROAD: Hazel Dell Pkwy COUNTY: HBmillan SECTION: 4 DLZ TOWNSHIP: 17N ENCUMBERS KEY N0. 28.14 44 900 007506 018 INDYANA,LLC RANGE: 4E 157 EAST MARYL STREET INDIANAPOLIS,INDIANA 46204 317 8334120 REVISED UNIFORM PROPERTY OR EASEMENT ACQUISITION OFFER Date: March 15,2016 DES.NO.: 1297561 PROJECT: 116 St. &Hazel Dell Pkwy. PARCEL: 1 COUNTY: Hamilton TO: Thomas M.Crowley,Trustee of the Thomas M. Crowley Revocable Trust clo J.Michael Antrim,attorney Church Church Hittle&Antrim TN—,-9-'0'-Street Noblesville,IN 46061 The City of Carmel, Indiana, is authorized by Indiana law to obtain your property or an easement across your property,for certain public purposes.The City of Carmel,Indiana,needs your property for a public highway.improvement known as 1297561; 116th St. &Hazel Dell Plcwy, and needs to take the property as described on the attached legal description. It is our opinion that the fair market value of the property we want to acquire from you is $14,500.0 , and,therefore, the City of Cannel,Indiana, offers you 14 500.00 for the above described property.You have thirty(30) days from this date to accept or reject this offer. If you accept this offer, you may expect payment in full within ninety(90)days after signing the documents accepting this offer and executing the deed, grant or easement, and provided there are no difficulties in clearing liens or other problems with title to the land.Possession will be required thirty(30)days after you have received your payment in full. Unirann Oftrcr REVISED 09!2015 Page 2 Project: 1297561; 116th St. &Hazel Dell Pkwy. Parcel: 1 HERE IS A BRIEF SUMMARY OF YOUR OPTIONS AND LEGALLY PROTECTED RIGHT'S: 1, By law, the City of Carmel, Indiana, is required to make a good faith effort to purchase your property. 2. You do not have to accept this offer and the City of Carmel,Indiana,is not required to agree to your demands. 3. However,if you do not accept this offer, and we cannot come to an agreement on the acquisition of your property, the City of Carmel, Indiana, has the right to file suit to condemn, and acquire theproperty in the county in which the real estate is located. 4. You have the right to seek advice of an attorney,real estate appraiser or any other person_of your choice on this matter. 5. You may object to the public purpose and necessity of this project. 6. If the City of Carmel, Indiana, files a suit to condemn and acquire your property and the court grants its request to condemn, the court will then appoint three appraisers who will make an independent appraisal of the property to be acquired. 7. If we both agree with the court appraisers'report,then the matter is settled.However,if either of us disagrees with the appraisers'report to the court,either of us has the right to ask for a trial to decide what should be paid to you for the property condemned. 8. If the court appraisers' report is not accepted by either of us, then the City of Carmel, Indiana,has the legal option of depositing the amount of the court appraisers' evaluation with the court. And if such a deposit is made with the court, the City of Carmel, Indiana, is legally entitled to immediate possession of the property. You may, subject to the approval of the court,make withdrawals from the amount deposited with court. Your withdrawal will in no way affect the proceedings of your case in court, except that, if the final judgment awarded you is less than the withdrawal you have made from the amount deposited, you will be required to pay back to the court the amount of the withdrawal in excess of the amount of the final judgment. Umfoim Offer REVISED 0412015 Page 3 Project: 1297561; 116th St.&Hazel Dell Pkwy. Parcel: 1 9. The trial will decide the full amount of damages you are to receive. Both of us will be entitled to present legal evidence supporting our opinions of the fair market value of the property or easement. The court's decision may be more or less than this offer.You may employ, at your cost, appraisers and attorneys to represent you at this time or at any time during the course of the proceeding described in the notice. If you have any questions concerning this matter,you may contact us at: ATTN: Gina M.Hansen,Land Agent RWS South,Inc. 5214 South East Street,Suite D-2 Indianapolis,IN 46227 Phone: 317.781.9723 Email: gina@rwssouth.com This offer was made to the owner via"Certified"mail No. 7015 1520 00012633 3010 Thomas M;Crowley,Trustee of the Thomas M.Crowley Revocable Trust c/o 1.Michael Antrim,attorney of Hamilton Count n (Date) BY: (Signature) Gina M.Hansen,LandAgent (Printed Name and Title) Agent of: City of Carmel,Indiana Uniform Offer REVISED 0412015 Page 4 Project: 1297561; 116th St. &Hazel Dell Pkwy. Parcel: 1 If you decide to accept the offer of$14,500.00 made by the City of Carmel, Indiana, sign your names below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER 1,Thomas M. Crowley,Trustee of the Thomas M. Crowley Revocable Trust, owner of the above described property or interest in property,hereby accepts the offer of$14,500.00 made by the City of Carmel,Indiana,on thisZ b'�} day of —F— ,2016. Thomas M.Cro yet ocable r Original Offer $14,500.00 Thomas M.Crowley,Trustee Total Amount $14,500.00 i I NOTARY'S CERTIFICATE STATE OF: [A-Q/- : SS: COUNTY OF i t-- o Subscribed and sworn to before me thi day of f 6� 4 ,2016. A t. Signature Painted NameM AN I A My C6n'lmissioli eipires c t IS l qm a resident of Tt� 1 J County. untroim offer RBVISIM 04/2015 QUIT CLAIM DEED (RELEASE) Form RQCD-1 Des.No.: 1297561 Revised 07/2014 Project: 11611'St.&Hazel Dell Pkwy. Parcel: 1 Page: 1 of 2 TIRS INDENTURE WITNESSETH, That American Aggregates Corporation/Martin Marietta Aggregates,, the Grantor of Hamilton County,State of Indiana Releases and Quit Claims to the CITY Or CARMEL,INDIANA,the Grantee, for and in consideration of the sum of Ten and N6/100 Dollars 10.00) (of which said sum $10.00 represents land and improvements acquired and $0.00 represents damages) and other valuable consideration, the receipt of which is hereby acknowledged,all right,title,interest and possessory rights which the Grantor may have in Real Estate situated in the County of Hamilton,State of Indiana,and being more particularly described in the legal description attached hereto as Exhibit"A"and the Right of Way Parcel flat attached hereto as Exhibit`B",which exhibits are incorporated herein by reference, the nature of which said rights,the Grantor claims,arose or arise as follows; Grantor has the right of first refusal. The undersigned represents and warrants that he is/she is/they are a duly elected officer of the Grantor;that the Grantor is a corporation validly existing in the State of its origin and, where required, in the State where the subject real estate is situated; that the Grantor has full corporate capacity to convey the real estate interest described; that pursuant to resolution of the board of directors or shareholders of the Grantor or the by-laws of the Grantor lie/she/they has/have full authority to execute and deliver this instrument on its behalf and that said authority has not been revoked; that he is/she is/ they are therefore, fully authorized and empowered to convey to the City of Carmel,Indiana,real estate of the Grantor,and that on the date of execution of said conveyance instruments he/she/they had fill authority to so act; and that all necessary corporate action for the making of this conveyance has been duly taken. Interests in land acquired by the City of Carmel,Indiana Grantee mailing address- Department ddressDepartment of Engineering One Civic Square,Carmel,IN 46032 Form RQCD-1 Des.No.: 1297561 Revised 07/2014 Project: 116'h St.&Hazel Dell Pkwy. Parcel: 1 Page: 2 of 2 i IN WITNESS WHLREOF,the said Grantor has executed this instrument this day of 2016. American Aggregates Corporation f Martin Marietta Aggregates j I By: (Seal) By: Signature Signature Printed Name Printed Name STATE OF: SS: COUNTY OF.- Before F:Before me,a Notary Public in and for said State and County,personally appeared American Aggregates Corporation/ Martin Marietta Aggregates By the Grantor,in the above conveyance,and acknowledged the execution of the same on the date aforesaid to be his/her/their, voluntary act and deed and whom,being duly sworn,stated that any representations contained therein are true, Witness my hand and Notarial Seal this day of ,2016. Signature Printed Name My Cominission expires I am a resident of County. This instrument was prepared by Douglas C.Haney,Corporation Counsel,City Hall, One Civic Square, Carmel, Indiana 46032 After recording,return deed to:Douglas C.Haney, Corporation Counsel, City Hall, One Civic Square, Carmel,Indiana 46032 I affirm,under the penalties for perjury, that I have taken reasonable care to redact each and every Social Security number from this document,unless it is required by law.Douglas C. Haney CONFIRMATION OF RECEIPT OF BOOKLET AND CONFIRMATION OF OPPORTUNITY TO ACCOMPANY APPRAISER ON INSPECTION DES. NO.: 1297561 PROJECT: 116"'St. & Hazel Dell Pkwy. PARCEL: 1 COUNTY: Hamilton The booklet titled, "ACQUISITION,Acquiring Real Property for Federal And Federal-Aid Programs and Projects"was provided. i The opportunity to accompany the appraiser on the physical inspection of the subject property was provided. Thomas ey Rev bl rust Date Signature:Thomas M. Crowle , Trustee CONFIRMATION OF RECEIPT OF BOOKLET AND CONFIRMATION OF OPPORTUNITY TO ACCOMPANY APPRAISER ON INSPECTION i i DES.NO.: 1297561 PROJECT: 116"St. & Hazel Dell Pkwy. PARCEL: 1 COUNTY: Hamilton The booklet titled, "ACQUISITION, Acquiring Real Property for Federal And Federal-Aid Programs and Projects"was provided. The opportunity to accompany the appraiser on the physical inspection of the subject property was provided. Thomas M. 2RevwTrust 2-� B Date Signature:Thomas M. Crowlek, Trustee i E REAL ESTATE CODE rtla pc, 1 Farm -� Request for Taxpayer Give Form to the (Rev.Ducembar2014) Identification Number and Certification requester.Do not Depadrrten1=Treasury send to the IRS. Intern s]Rrrvenue Service 1 Name(as shown on your Income-tax return).Name is required on this line;do not leave this line blank. Thomas M. Crowley,Trustee N 2 Business nameldisregarded entity name.If different from above Thomas M.Crowley Revocable Frust a 3 Check appropriate box for federal tax classification;check only one of tha following seven boxes: 4 Exemptions(codes apply only to �"IndlvlduaVsole proprietor or �C Corporation �S Corporation F91Partnershf ng certain entitles,not lndlvtduals;sae �� P P P rP P IrteUuctions on page 3): m rsingte•member LLC KL u gLimited gabi4ty company.Enter the tax ciassifca@on(C-C corporation,S=S corporation,P=partnership)► F�remptpayeecode litany) `o 2 I�jNote.For a singla•member LLC that Is disregarded,do not check I.L.C.check the appropriate box In the Mea ova or E�mption from FATCA reporting 7) the tax classification of the single-member owner. code Of any) IL u Q1Olher(seelnstrucllons)► (AW"toOMMIo�e�IWT d.1"dof oU.S.) P- L= 5 Address(number,street,and apt.or suite no.) Requester s name and address(optional) o 501 Pennsylvania Pkwy.,Suite 160 y 6 City,stale,and ZIP code v) Indianapolis,IN 46280 7 List account number(s)here(opllonal) Taxpayer Identi€ication Number(TIN) Enter your TIN In the appropriate box.The TIN provided must match the name given online 1 to avold I social security number backup withholding.For individuals,this Is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I Instructions on page 3.For other n LLI — entities,it is your employer identification number(El M).If you do not have a number,see Holy to get a TIN an page 3. or Note.If the account Is in more than one name,see the Instructions for line 1 and the chart on page 4 for Employer Identification number guidelines on whose number to enter. Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer ldentification number(or I am walling for a number to be Issued to me);and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. 1 am a U.S.citizen or other U.S,person(defined below);and 4.The FATCA code(s)entered on this form(if any)In ating that I am exempt from FATCA reporting is correct Certification Instructions,You must cross out i above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all inter ividendso eyyr tax return.For real estate transactions,Item 2 does not apply.For mortgage Interest paid,acquisition or abandon s red prop hcellatlon of debt,contributions to an individual retirement arrangement(iRA),and generally,payments other than ince and ivldends, u 7not required to sign the certification,but you must provide your correct TiN.Seethe Instructions on page 3, sign Signature,of �/ r Here U.s.perso Date► Lrj �j General Instructions •Form 1099(home mortgage Interest),1098-E(student loan interest),1099 7 (tuition) Section references are to the internal Revenue Code unless othervdsa noted. •Form 1099•C(canceled debt) Future developments.Information about developments affecting Form W-9(such -Form 1099-A(acquisition or abandonment of secured property) as legislation enacted a8erwo release It)Is at mwllragov/hv9. Use Farm W-9 only if you are a U.S.person(including a residon(ellen},to Purpose of Form provide your correct TIN. An Individual or entity(Form W9 requester)who is required to fila an Information Ifyou do not return Form W-9 to the requester with a TIN,you mfght he subject return with the IRS must obtain your correct taxpayer Identification number(TIN) to backup withholding.See Whatis backup mvifhfickibig?on page 2. which may be yoursoclal security number(SSN),Individual taxpayer identification By signing tine fliled•out form,you: number(ITIN),adoption taxpayarldantificallon number(ATIN),or employer 1.Certify that the TIN you are giving Is correct(oryou are waiting for a number Identification number(EIN),to report on an information relum the amount paid to to be issued), you,orother amount reportable on an Information return,Fxamples of Information returns Include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or -Form 10904NT(Interesteomed or paid) 3.Claim exemption from backup withholding If you are a U.S.exempt payee.If -Form 1099-DIV(dividends,including those from stacks or mutual(ands} applicable,you are also certifying that as a U.S.person,your allocable share of any partnership Income from a U.S.trade or business Is not sub)ect to the -form 1090-NUSC(various types of income,prizes,awards,or gross proceeds) withholding lax an foreign par(ners'share of effectively connected Income,and -Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered an this form(if any)Indicating that you are brokers) exempt from the FATCA reporting,Is correct See Met Is FATCAroporting?on -Form 1099•S(proceeds from real estate transections) page 2 for further Information. -Form 1099-K(merchant card and third party network transactions) Cal.No.10231X Fonts Vit-9(Rev.12-2014 II WARRANTY DEED Form WD-1 Des.No.: 1297561 Revised 07/2014 project: 116111 St.&Hazel Dell Pkwy. Parcel; 1 Page: 1 of 2 THIS INDENTURE WITNESSETA That Thomas M. Ctowley, Trustee of the Thomas AL Crowley Revocable Trust,the Grantor, of Hamilton County, State of Indiana Conveys and Warrants to the CITY OF CARMEL,INDIANA, the Grantee,for and in consideration of the sum of Fourteen Thousand Five Hundred and No/100 Dollars ($14,500.00) (of which said sum $14,500.00 represents land and improvements acquired and JQ.00 represents damages) and other valuable consideration, the receipt of which is hereby acknowledged, certain Real Estate situated in the County of Hamilton, State of Indiana,and being more particularly described in the legal description(s)attached hereto as Exhibit"A"and depicted upon the Right of Way Parcel Plat attached hereto as Exhibit'B",both of which exhibits are incorporated herein by reference. This conveyance is subject to any and all easements,conditions and restrictions of record. The Grantor hereby specifically acknowledges and agrees that the Real Estate conveyed herein is conveyed in fee simple and that no reversionary rights whatsoever shall remain with the Grantor,or any successors in title to the abutting lands of the Grantor, notwithstanding any subsequent abandonment, vacation, disuse, nonuse, change of use, conveyance, lease and/or transfer by the Grantee or its successors in title,of a portion or all of the said Real Estate or any right of way,roadway or roadway appurtenances established thereupon, This acknowledgement and agreement is a covenant running with the land and shall be binding upon the Grantors and all successors and assigns. The undersigned represents and warrants that he is the Trustee of the Thomas M. Crowley Revocable Trust,that pursuant to the Trust Agreement he has full authority to manage the affairs of said Trust and sign and execute documents on its behalf and that said authority has not been revoked,and that lie is therefore,fully authorized and empowered to convey to the City of Carmel,Indiana,real estate of this Trust,and that on the date of execution of said conveyance instruments they had full authority to so act, The Grantor assumes and agrees to pay the 2015 payable 2016 and 2016 payable 2017 (through the date of conveyance)real estate taxes and assessments on the Real.Estate.This obligation to pay real estate taxes and assessments shall survive the conveyance of the Real Estate and shall be enforceable by the Grantee in the event of any non-payment of such real estate taxes and assessments. Interests in land acquired by the City of Carmel,Indiana Grantee mailing address: Department of 1?ngineering One Civic Square,Carmel,IN 46032 Form WD-1 Des.No.: 1297561 Revised 077/2014 Project: 116th St.&Hazel Dell Pkwy. Parcel: 1 Page: 2 of 2 IN WITNESS'4V1 EM,OT,the said Grantor has executed this instrument this 2 p`— day of Au6v ,2016. Thomas r ey v able Trust (Seal) Signature Thomas M.Crowley,Trustee Printed Name STATE OF: �yl "'� A COUNTY OF: Ss: Before me,a Notary Public in and for said State and County,personally appeared Thomas M. Crowley, Trustee of the Thomas M. Crowley Revocable Trust, the Grantor,in the above conveyance,and acknowledged the execution of the same on the date aforesaid to be his voluntary act and deed and whom, being duly swom, stated that any representations contained therein are true. Witness my hand and Notarial S# this �' day of 2016. Signature Printed Name_ 7-0` (ul My Commission expires I am a resident of YAM 1 G--lc) 1 y County. This instrument was prepared by Douglas C.Haney, Corporation Counsel, City Hall, One Civic Square, Carmel,Indiana 46032 `< . . .After recording,return deed to: Douglas C. Haney, Corporation Counsel, City Hall, One Civic Square, Carmel,Indiana 46032 I pf'r{� under the penalties for perjury, that I have taken reasonable care to redact each and every Social Security number from this document, unless it is required by law.Douglas C. Haney E f R SALES DISCLOSURE FORM - ` State Form 46023 QW/12-11} SDFID Prescribed by Depattment of Local Gaverabwhl.Finauee County Year Unique ID ^ ? PursaanttolC5-Ll-ss WrDatci Wet�'v PRIVACY N(yrtur:7lwtolophnnenumhersandSoclalsacultynumhersofthcpartlesanthis form are confidential ateordin - ^^_S- �r=:iF.r 'L "�4i>Y� - ": PRO" ..n.t..y4'r>.4 - ..41<sisz._7n.ce^.`_•:•r=;+ ^';:':.:,..�..:. o ted: `R#lI�lZ? fi`Fa' 1-M Tb '_tam CO ' ,.._.,.,,. .d_.A�-StiiN%±_ _ trtl'i .., y�• 7.�,A? -. -.: ;L�--_�4.�.1:- .F. .:. <{„ 3- .;A.:._r ky.il :)ii. <S:..a."-:.''"•`*' r: � "t•.1-...5.'s,- >: _ a�S•Y-'G�C"o. -..Y&.ra.:]l•Y'r.. �..� .._•.Y,.';i.---'. •2:>i3y.:;oi...�,r.,.- o,..a. :�i; 1- R'y vj� �z,A��?�4.��.'-���LX�.�1�SF��iLtJ±'I1;�<l�[XST>- 1.Prapero,Number Check baxifappllcableto 5 Complete Address of Property 6.Complete Tax D1111ugAddress(7fd1)fa)vntfrom parcel property address) A•7 29-14-04-000-007.006-1718 ❑✓ 7-spelt 11312 Hazel Dell Parkway One Civic Square 3.Land Carmel,IN 46033 Carmel,IN 46032 ❑ 4.1mprovement T LegarDescrlptlonafPareelA:A part of the Northeast Quarter of S4,T1 7M,W,Hamilton County,Indiana, E) ❑ 2.spllt ❑ 3.Lund ❑ 4,Improvement 7.Legal Desctrption ofParcelll: _ __ ^Z.0`.'til:�"<"-;EY:,i:�''�.�y•,N+..:dv _- - - - - - -�_ _ r�+s-- -:x_hn::_w:< �:-:. "SD..;At"� E.,A�U13• -�'E1+r1�S2 I _.I .-T 'BJ."f3^ _ir�••YVY�' `fi`A�Rf? Y....:,:s=}.:.;•.:.. _ �... i: 1' AJ" .J. TaQ :Y.� O ,l- _1�.. -_l`.�_ - - r. 5.. ••�/14N.3:t�,t;(:G,. .- ?%F...<�.:,'„'`,'„ �6'..s >?. •4 xE' f� .-1c.,. ...5-C.,,�ti.._ �.: -.yar x..,..:r_-,= A - :;3.� :�:2��c+�.-�u.[..�ASs=._,- 1f` -r•a. �'.,i+,c... i:�•:-'- �4.:,..w�3 -z����- •-:'„[�� �- c,.�.w,r,Y:?.>'`a'�4. .. x-tet^- - -•se :. .4a_a,::i,. -- .c..•.,. :y {r{ :atv" '.-;:�^1'i- %v..._ `,.L•-_ _,4S !�n�,}�(;�,. y Jam'%itJ.�.r -_tiL': fi..csQx •vh c.=.�?.9._. �IilTl-�SA.���,...S.a __ - ::le^1s' .:.T.wi2.',_a•�� .•'l�at:?dk��.•h...:�iS.�A�-ay.__a. ircondllioniapplles,Olerls subject to disclosure andadlsclosure Ming fee. 1.Conveyance date(taer/op/rrrq: YES No CONDITION © ❑ 1,A transfer of real property interest for valuable 2.Total number of parcels: 1 consideration. 3.Describe any-unusual or special circumstances related to this ❑ © 2.Buyer is an adjacent property owner. sale,including the specification of any less-than-complete 0 ❑ 3.Vacant land. ownership interest and germs of seller financing. ❑ [Z] 4,Exchange for other real property("Trade's. Permanent right-of-way acquired in conjunction with the 116th ❑ 0 S.Seller paid points.(pivvidethavalmTable creem rz,} &Hazel Dell Roundabout Drolect. [Z ❑ 6.Change planned in the primary use of the property?(De=1be is speclaldramuearimin Table Cftam3.) ❑ 0 7.Existence of family or business relationship between buyer and seller.(Complc[eTable Cltem4.) ❑ © 8.Land contract. Contractterm(m., and contract date(blbr/op/m-o; ❑ 9.Personal property included in transfer.movia.artwrue Yrs No CONDITION anbteCltemS) ❑ © 10.Physical changes to property between March 1 ❑ ® 4.Family or business relationship existing between and date of sale,(Darerlbelnspeclelcbarmsbatcesln TafiieCltomSC) buyer and seller? ❑ © 11.Partial interest(Daraibe[nspacta►dnums[ane�rinTable c![cros.) Amount of discount: $ Disclose actual vahlain motley,property,a service,anagracment,or other consideratiom ❑ © 12.Easements or right-of-way grants. Ifcanditiousl3-15 apply,mars are suujecttodisclosureLutnodtsclosuretlltngfee. 5.Estimated value of personal property: $ Yr.4 No CONDITION 6.Sales rice: $ ❑ 13.Document for compulsory transactions as a YES No CONDITION result of foreclosure or express threat of ❑ © 7.Is the seller financing sale? If yes,answer foreclosure,divorce,court order,judgment, questions(8-13). condemnation,or probate, E] �] 14.Documents involving the partition of land E] © 8.Is buyer/borrower personally liable for loan? between tenants in common,joint tenants/or ❑ © 9.Is this a mortgage loan? tenants by the entirety. 10.Amount of loan: $ © ❑ 15.Transfer to a charity,slot-far-profit organization, 11.Interest rate: % or government. 12.Amount inpoints: $ 13.Amortization period: i INDIANA SALES DISCLOSURE FORM 5DF ID: Page 2 urY.`r,'=.t,•'N � .slz<.Y -`r-.'.r"k y',,+ii:.-L"Y:t-�:-`.-i>-'b4'.--7=..I--;�.a'f��'s.r"�-�-._•`x�-r'.;�:r.,.?2.�f`r:1'-.y.':-r+.`i2r3>•;>cl�-_v>i::_>...:tf,�v.fv''S.�c'Sy"= ''^-'."..A-L-3-_"-' -�rC•_:=?.cne.�u.L:aa3,.-: Gina M Hansen Land Agent Prepareraf the Sales Disclosure Form Title 5214 S.East Street,Suite D-2 _ RWS South,inc. Address(Numberand Street) Compmiy indianwoiis IN 46227 317.781.9723 ginagmssouth.com City,Statq and 7rP Code Telephane Numb E-mail 1,. �v. .:1._. - ,fit _i ='i�tr'�: .•;y_ :.a:•.=''F:�`-- "-•'s�_`��.,.,- . . L' 'l'l fy �'c`.'-. "u�:•.;.n U E<z ,.k z .q,,-_. nc#�',f�ii3a8,t3.^>-t''a' -i:Y<�.;wa�:�.,tit•`'^:��-.�;"'...`y`^>'^,'a'5.3i.�ti;i.. -- Thomas M Crowley Revocable Trust Sellerl-Name as appears on conveyance document Seller2-Name asappearsanconveyaa document 501 Pennsylvania Pkwy,.__Suite 160 Address(Number and Street) Address(Number and Street) than polis,IN 46_H0 Clty,State;and7JPCode City,State,all dZIP C04 Tele hanunumber E-mail Telephone Number E-mail Under penalties of perjury,l hereby certify that this Sales DisclFwRoh ,to ta 4eal - ge and belief,is true,correct and complete as required bylaw,and is prepared in accordancIC ty Sales Disclosure Act'. Signature ofseller nature ofSeller Thomas M.Crowley,Trustee PrintedNameo Seller S!nDate ALAI DD ntedNameo Seger SJqnDate AIA DD --sv -- - �lr_>3.11X1:kt 5�,1x13A�r�,�'fi... ,A� '�7=l:�iinit� .......M4. City of Carmel Indiana Btryer 1-Name as appears on conwyance document Buyer -Name as appears on conveyance document One Civic Square Address(Number and Street) Address(Number and Street) Westfield,IN 460674 Clty,State,and ZIP Cade City,Statc,and ZIP Coda 317.571.2400 Tete homaNtrmber Lrtnall Telc hone Number 6-mall THH SALES DISCLOSURE FORM MAY DB USED To APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. YIN NO CONDITION YES NO CONDITION ❑ ❑ 1.Will this property be the buyer's primary ❑ [A 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county. ❑ [A S,Wind Power Device One GMG,Square Address(NamberandStreet) ❑ [0 6.Hydroelectric Power Device Westfield fid 46074 Hamilton ❑ ❑ 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County E] FA2.Does the buyer have a homestead in Indiana to be El [0 B.Is this property a residential rental property? vacated for this residence? Ifyes,provide 9•Would you like to receive tax statements for this complete address ofresidence beingvacated, property via e-mail?(Provide contact information including county: below.Please see instructions for more information. Not available in aff counties) Address(Number aitd Street) City,State ZIP Code County Primary property mvrrer contact name C••maB Under penalties of perjury,I hereby certify thatthis Sales Disclosure,to the best of my Irnowledge and belief,is true,correct and complete as required by law.,and is prepared in accordance with IC 6-2.1-5.5,"Real Property Sales DisclosureAct".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction Is being filed.) SignatureofBuyerl Stguature of fter2/Spouro PrintedLegalNameoffl%verI Sign Date(Amr/Do/rrrr) Printed Legal Name ofBuyar2/Spmue 40 Data(AtAi/nn/Yrrs) Last 5digits ofNuyerIDriver's State LastSDigitsofSocialSecuriVNainber LostSdigits ofBuyer2/Spouse Driver's State Lost 5DigitsofSocialSecurity License/1A10UierNutnber Number License/!D/0therNumber � INDIANA SALES DISCLOSURE FORM oDYon Page � 001k,-ft-0-3100-SHIA MEN gg Thu county*ssomr must verify and complete itoras I through 14 and stamp the sales disclosure form before sundIng to the auditor Assessor Stamp 10.Identiry physical changes to propertybetween March I and date of sale. E] 11.Is form completed? 12.State sales fee required? 13.Date of sale ptif/PPjYYYYj: 14.Date form received(AjAj1DD1nyY)� Itenss 15 through 10 are to be coMpleted bX thoassessor Whenvalldating this sale: YES NO CONDITION iS,if applicabl%identlf�any additional special circumstances relating to validation ofsale. E] 16.Sale valid for trending? 18.Validated by-. osure fee amount collected- YUS NO Auditor Stamp 2.0therl,ocal[Feo: El El 6.1sformcampleted? 3.Total Fee Collected.- E] E] 7.Is state fee collected? 4.Auditor receipt booknumbert S.Date of transrer(ainIpplwM: | ! i ___—_____—_____________—___________________— __—________—___--____ Parcel Number Address ofProperly(Number and Street) ! Check a that apply: City,state,and ZIP Code ofProperly F1 Homestead DSoIargnergy Wind Power E]Hydroelectric El Geothermal El Rental Property Auditor SIgnature Dote(wilDDIMY) Electronic Statement(e-mall) A person who Imowingly and intentionally falsifies value of transferred real property�or omits or falsifies any information required to be provided in the sales disdosura farm commits a Class C felony, ! ! ' i INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 1 INSTRUCTIONS Indiana lawrequires a sales disclosure form(SDF)to be reviewed for completeness by the county assessor before being forwarded to the county auditor and must be completed whenever a conveyance document(see definition below)is filed.The county auditor may notaccepta conveyance If (1)the sales disclosure form is not included with the conveyance document,or(2)the sales disclosure form is Incomplete and/or is not stamped by the county assessor. A separate SDF is required for each parcel conveyed,regardless of whether more than one(1)parcel is conveyed tinder a single conveyance document. However,only one(1)SDR is required if there is a single conveyance document that conveys two(2)or more contiguous parcels located entirely within a single taxing district A person filing a sales disclosure form marked onlywith sales conditions subject to a disclosure Mingfee shall pay a fee of ten dollars($10.00)to the county audltor. Definitions Conveyance Document-means any transfer of areal property interest for valuable consideration to include any document,deed,contract of sale, agreement;judgment,lease that includes the fee simple estate and is for a period In excess of ninety(90)years,quitclaim deed serving as a source of title,document presented for recording thatpurports to transfer areal property interest for valuable consideration. Filers are required to disclose,but are notsubject to a fee when filing the following:documents for compulsory transactions as a result of foreclosure or express threat of foreclosure,divorce,court order,judgment;condemnation,or probate;documents Involving the partition of land between tenants in common,joint tenants,or tenants by the entirety;transfer to a charity,not for-profit organization,or government;or easements orright-of-way grants.Filers should note that the following Items do NOT require a sales disclosure form be prepared!security interest documents such as mortgages or trust deeds;leases less than 90 years;agreements and other documents for mergers,consolidations,and incorporations involving solely non-listed stock; quitclaim deeds notserving as a source of title. Additionally a sales disclosure form is not required for a transfer for no consideration or a gift;or when rerecording to correctprior recorded document Personal property-means Items that are no t attached(built-in or affixed)to the real estate(land and buildings).This might include iiems such as washers,dryers,win dow treatments,stoves and refrigerators.Other items considered personal property are boats and other vehicles,inventories Olvestock,goods in process or for trade,or agricultural commodities)and machinery used in farming or manufacturing. A.PROPERTY TRANSFERRED A single sales disclosure form may include multiple properties as long as the parcels are contiguous and located entirely in a single taxing district. All parcels and property listed In this box must be conveyed on a single conveyance document.Parcels and property on separate conveyance documents must be submitted on separate sales disclosure forms.If the transaction consists of more than three parcels,an additional list of parcel numbers and lot sizes must be attached to this document 1. Property Number:State and/or local required property number(s)(including all dashes and decimals on the sales form).An Identification number that is assigned to a parcel of land to identify that parcel from any other parcel within a given taxing jurisdiction.List all parcels separately using separate attachments if needed. Should the sales disclosure form be submitted prior to assignment of the State mandated 18 digit parcel number,either the parent parcel number or the name of the subdivision and the lot number as provided by the county planning departmentmust be included. If the property is personal property the county assigned ID is required. 2. Split:Check if the parcel is split,or section off,from another parcel included on this sales disclosure form. 3. Land:Check if this parcel Is land. 4. improvement:Check if this parcel includes buildings or structures. 5. Complete Address of Property:Provide the street address or geographic location of the taxable real estate.A P.O box address is not acceptable. 6. Complete Tax Billing Address(if different from property address):Provide the owner mailing address for the owner of record.A P.O.box is acceptable. 7. Legal Description:Provide a legal description of real property by government survey,metes and bounds,orlotnumbers of a recorded plat A legal description is especially important for metes and bounds descriptions and new parcels.The legal description may be provided as an attachment to and/or uploaded with the sales disclosure form. B.CONDITIONS The information in this section is used to determine sales characteristics,establish marlcetvalue,and determine applicability of the sale and for use In ratio or otherstudfes.The appropriate response should be filled in for all conditions thatapply to the sale.Please note thatwhile indicatingthat certain conditions will resultln notpaying a filing fee,the buyer/grantee or seller/grantor is still responsible for completing the farm in full. 1. A transfer of real property interest forvaluable consideration:Atransfer of a real property in exchange for money,performance,or a promise of performance. 2. Buyer is an adjacent property owner:A person who lives on a border of listed property. 3. Vacant land:A parcel In which there is no improvement value. 4. Exchange for the other real property C'Trade"):Art exchange of propertyfor another property,commodity,service,or item of like value. Trading does not require the use of money,however money may be used for a portion,butnot all,of the trade, S. Seller Paid Points:An incentive by the seller to acquire a buyer. 6. Change planned in the primary use of the property:Identify If the property's classification will be changed from Its current status,i.e., residential to commercial.Describe in special circumstances,table C,item 3. 7. Existence of family or business relationship between buyer and seller:Whether the buyer and seller have a mutual interest in the listed property. 8. Land contract:Contract term and Contract date:A purchase allowing the grantee possession of the property and the grantor retaining the deed to the property until the terms of the con tract are m et.The contract term Is listed as a two digit number. 9. Personal property included in transfer:Property that is not permanently affixed to and not a part ofthe real estate,and further defined by state statute and rule. INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 2 10. Physical changes to property between March 1 and date of sale:A change from current property class status,changed to a different use,Le, grocery store changing to bowling alley. 11, Partial interest:Individual not having 100%interest in said property.Provide a description in special circumstances In table C item 3. 12. Easements or rIght-of-way grants:Right held by ane party of said property to use the land of another for aspecific purpose. 13. Document for compulsory transactions as a resultof foreclosure or express threat of foreclosure,divorce,court order,condemnation,or probate:Court ordered transaction. 14. Documents Involving the partition of land between tenants in common,joint tenants,or tenants by the entirety: Split of property between two or more individuals who own inseparable interest in a parcel ofreal property. 15. Transfer to a charity,not-for-profit organization,or government entity:Identify If the property will be owned by a charity,not-far-profit organization or a government entity as a result of the transfer. C.SALES DATA The conveyance date and sales price of the property transfer Is to be printed in the spaces provided.Any unusual or special conditions of the sale that may affect the sales price or terms of the sales agreementshould also be described.With regard to personal property(see definitions below), the buyer or seller must enter an estimated value of the personal property included in the sale.Similarly,the buyer and seller must enter the amount of seller paid points as applicable. I. Conveyance date:Date the conveyance documentis signed.Effective date of the deed or document or the date of the most recent signature on the conveyance document,This date determines what year the sale may be used for trending calculations and may also be referred to as the date of the sale. 2. Total number of parcels:Total number of parcels included an the conveyance document.Each should be listed separately in tableA above.If there are more than two parcels Involved in the transaction,additional parcel Information mustbe included in an attachment to this form. 3. Describe anyunusual or special circumstances related to this sale,includingthe specification of any less-than-complete ownership interest and terms ofseller financing. 4. Is there a family or business relationship existing between buyer and seller?Do the buyer and seller have a mutual interestin said property? State the amount of any discount from market value. 5. Provide estimated value of personal property:This should be the amount of property not permanently affixed to said parcel.Refer to number 8 in section B. 6. State the price at which said property is actually said. 7. Identify if the seller is financing the sale: If the answer is yes to this question,C.Sales Data,items 7-13 must be completed. B. Ifselleris financing,indicate whether the buyer/borrower personally liable for loan. 9. Ifselleris financing,Identify 1f this is a mortgage loan. J.D. Ifselleris financing,state the amount of loan being financed by the seller, 11. If seller is financing,state the interestrate shown as a percentage. 12. State the amount In points,if applicable.Principal amount deducted, 13. Ifseller Is financing,state the amortization period or the time needed to repay a loan on said property, D.PREPARER The individual preparing the sales disclosure form Is to provide full name,title,company,full address,telephone number,and email.The contact information provided is used by county officials to validate the sale and must be valid for at least 30 days following the filing of the sales disclosure form.Telephone number and email are requested in order for the assessor to validate the sale.Telephone numbers provided are retained as confidential. E.SELLERS)/GRANTOR(S) Sellers)/grantor(s)are to provide the full name,address,telephone number,and email for seller(s)or entity as applicable,The contact Information provided is used by county officials to validate the sale and mustbe valid for at least 30 days following the filing of the sales disclosure form. If there are more than two individuals or entities involved in the transaction,additional ownership information must be included in an attach mentto this form.Telephone number and email are requested in order for the assessor to validate the sale. Telephone numbers provided are retained as confidential.Sellers)/grantor(s)are required to sign certifying that the sales disclosure is true,correct and complete as required by law,and Is prepared in accordance with IC 6-1.1-5.5. The buyer/grantee,seller/grantor or their representatives mustsign one(1)sales disclosure form,or ifthe parties do not agree on the information to be included on the completed form,each party must sign and file a separate form For conveyance transactions that involve more than two(2) parties,it is sufficient for one(1)transferor and one(1)transferee to sign the SDF.If anyone other than the buyer/sell or or an attorney of the buyer/seller Is signing the form,a properly executed Power of Attorney must be completed and attached,A person who knowingly and Intentionally falsIfles value of transferred real property,or omits or falsifies any information required to be provided in the sales disclosure form commits a Class C felony. F.BUYERS)/GRANTEG(S)—APPLICATION FOR DEDUCTIONS AND CREDITS Buyers)/grantee(s)are to provide the full name,address,telephone number,and email forbuyer(s)or entity as applicable,The contact Information provided is used by county officials to validate the sale and must be valid for at least 30 days following the filing of the sales disclosure form. If there are more than two individuals or entities involved in the transaction,additional ownership information mustbe included in an attachment to this form.Telephone number and email are requested in order for the assessor to validate the sale. Telephone numbers provided are retained as confidential.Tile buyer/grantee must also Indicate whether the property will be used as a residential primary residence. Buyers)/grantee(s)are required to sign certifying that the sales disclosure Is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5. The sales disclosure form may be used to apply for thehomestead standard deduction for this property.Individuals I i INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 3 filingfor the homestead standard deduction must provide theirfull legal name(as It appears In the records of the Social Security Administration), the last 5 digits of the driver's license(or state identification)number,and last five digits of theirsoeial securitynumber.III addition,a married individual must also provide their spouse's legal name(as it appears In the records of the Social Security Administration),last 5 digits of the driver's license(or state identification)number,and last five digits of the spouse's Social Security number, In the event that these numbers are not available,the individual may use a federal Identification number such as the Permanent Resident Card("A")number.This Information Is kept confidential to the extent possible under Indiana law.Failure to provide this Information may result in the Inability of the individual to receive the deduction. When an individual becomes ineligible to receive a standard deduction they must notify the county auditor of the factwithin 60 days of the date they first lose their eligibility.Failure to do so may result in substantial financial penalties,Including the repayinentof up to three years of unpaid taxes and a 10%penalty on taxes owed. The sales disclosure form may also be used to reapply for items 4-7 below to the extent that they already exlston this property,and state form 18865,Statement For Deduction Of Assessed Valuation(AttrlbutedTo Solar Energy System/Wind,Geothermal or Hydroelectric Power Device),is on file at the county auditor. The buyer(s)mustidentify all that apply to the property included on the sales disclosure,In addition,these deductions may require additional certification from the Indiana Department of Environmental Management;therefore,the buyer should work with the county j auditor's office to determine what Is needed to receive these benefits. L State If this property will not be the buyer's primary residence.Provide complete address of primary residence,Including the county of the residence. 2, State if the buyer has a homestead that will be vacated for this residence.If yes,provide complete address of the residence to be vacated, including the county of the residence. 3. Homestead-includes homestead standard deduction and supplemental homestead deduction, Ifsefected the property,is eligible for both the standard and supplemental deductions using the sales disclosure form. 4. Solar Energy Heatlng/Cooling System-state If this property has a solarenergy heating/cooling system. S. Wind Power Device-state If this property has a wind power device. 6. Hydroelectric Power Device-state if this property has a hydroelectric power device(state form 18865 mustbe on file). 7. Geothermal Energy Heating/Cooling Device Deductions-state if this property has a geothermal energy heating/cooling device(state form 18865 mustbe on file). S. Is this property a residential rental property?Identifyif this property will be used as a rental property. 9. Would you like to receive tax statements for this property via e-mail?Under HEA 1344-2009,a county may elect to offer taxpayers the option to receive property tax bills electronically.In these counties a property owner may file with either the county treasurer or county auditor to receive electronic statements.If a taxpayer elects to receive electronic statements,the choice remains in effect until the taxpayer changes e- mail addresses,or requests otherwise.Only one electronic statement can be sent per property;therefore,the person or entity exercising the option must designate a single individual to receive the statement.if an individual requests electronic statements In a county that does not offer them,the e-mail address will be held until such time as the county chooses to adopt the option.If a taxpayer chooses to change this preference,State Form 53954(Authorization for Receipt of Electronic Property Tax Statements)mustbe filed. You may also be eligible for other credits or deductions for which separate application may b e required. The buyer/grantee,seller/grantor or their representatives must sign one(1)sales disclosure farm,or if the parties do not agree on the information to be included on the completed form,each party must sign and file a separate form.For conveyance transactions that involve more than two(2) parties,It is sufficient for one(1)transferor and one(1)transferee to sign the SDF.If anyone other than the buyer/seller or an attorney of the buyer/seller Is signing the form,a properly executed Power ofAttorney must be completed and attached.A person who knowingly and intentionally falsifies value of transferred real property,or omits orfalsifies any information required to be provided in the sales disclosure form commits a Class C felony. PART 2-COUNTYASSFSSOR The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor. The county assessor is responsible for verifying the following information specific to each parcel included in the sales disclosure form.- 1. orm:1. Parcel ID.The parcel ID for the parcels covered on the sales disclosure form mustbe verified as correct and valid. 2. AV Land.The most recent assessed value of the land for each parcel. 3. AV Improvement.The mostrecent assessed value of fmprovement(s)for each parcel. 4. Value of Personal Property.The most recent assessed value of the personal property identified for this parcel,or an estimated value for the personal property Identified as determined by the county assessor. 5. AV Total.The most recent total assessed value for each parcel. 6. Property Class Code.The property class code maintained within the computer assisted mass appraisal system. 7. Neighborhood Code.The neighborhood code maintained within the computer assisted mass appraisal system. 8. Valid state assigned tax district. 9. Acreage.Lot sizes mustbe converted to numeric acreage. Additionally the following information mustbe provided for the sales disclosure form: 10, Identify physical changes to property between March 1 and date of sale,The county assessor Is responsible for determining whether or not significant physical changes have been made to the property between March 1 and the date of sale(conveyance date), 11. Is form completed?The county assessor has verified form has been properly completed. 12. Sales fee required?The county assessor should indicate if county auditor should collect sales disclosure filing fee,The sales disclosure fee is not required for table B items 13-15. INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 4 13. Date of sale.The county assessor indicates date of sale(the conveyance date)for use in statistical analysis and ratio study calculations. 14. Date form received.Date county assessor received sales disclosure form, Items 15 through 18 are to be completed by the county assessor when validating this sale.Processing the form to the auditor is not contingent on validation of the sale. 15, If applicable,Identify any additional special clrcumstancesrelating to validation of sale. 16, County assessor indicates If the salefsvalid for use intrending, 17, County assessor Indicates the sale validation process is complete. 18. Signature or initials of individual validating the sale. The county assessor and/or other assessing officials are responsible for verifying the sale as well.Verification of sales disclosure date is required prior to submitting sales data to the DLGF.To streamline and expedite the verification of a sale,itis strongly recommended that the county assessor verify each sale within 30 days ofreceipt of the SDF,as the assessor may find that the buyer and/or seller may not be located at the address provided on the form. Sales disclosureformsprovided in response to public records requests may not include telephone numbers, PART 3 COUNTYAUDITOR The county auditor Is responsible for correctly collecting the filing fee for all non-exempt sales transactions as well as ensuring thatall parties to the conveyance have completed and signed the form as required.The county auditor may notaccept the sales disclosure statement if(1)the buyer or seller falls to completely fill out their designated portions of the form,(2)the sales disclosure form is not included with the conveyance document; or(3)the sales disclosure fonn is incomplete and/or is not stamped by the county assessor.If the buyer or seller fails to completely fill out their designated portion of the form,the county auditor may not accept the conveyance document.The county auditor must also confirm the date the property was duly entered for transfer. 1. Disclosure fee amount collected:Enter the amount of the disclosure fee collected by the county auditor. 2. Other local fee:Enter the amount of other local fees collected for the transfer of the property.This amount should no t include the sales disclosure fee as required by the state. 3. Total fee collected:Enter the total amount of the fee collected for this transaction, The amount should equal the sum of part 3 item 1 plus part 3 Item 2. 4. Auditor receipt book number: Identify the receipt book number used for collection of the disclosure fee. 5. Date oftransfer. fin ter date entered in transfer book 6, Is form completed?Checkyes if the form is completed except for PART 2-COUNTY ASSESSOR,Items 15-18,which may not be completed prior to submission to the auditor. 7. Is fee collected?Checkyes If a sales disclosure fee has been collected for this sales disclosure form. 8, Attachments complete?Checkyes if the attachments required to support this sales disclosure form have been provided and are complete.If there are no attachments,checkyes. The countyauditor shall review each sales disclosure form and process any homestead credit or any of the deductions forwhlch the SDF serves as an application under IC 6-1.1-12-44[solar energy heating/cooling system,wind power device,hydroelectric power device,geothermal energy heating/cooling device deductions]and IC 6.1.1-20,4-3.5[homestead credit and standard deduction]. Sales disclosure forms provided in response to public records requests may not include telephone numbers, INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page S TABLES-Deductions covered undar the Sales BisclosuraPorml Listed below are certain deductions and credits that are avallable to lower property taxes in lndtana.Taxpayem may claim these benefits by filing an application with the Auditor in the County where the yraperty Is sltuatod.Tho previous mxh0t will facilitate filing,butitis not required. Applications for deductions against real property mustba filed during the year In which the deduction Issoughtto be effective for!axon payable In the fallovingyear.The filing deadline for deduction appllcatlous for mobllehamasand manufactured homes thar are not assessed asreal property Is the ltvolva months before March 31,urdessngted below, Tho deductionwill oppearoo the tax 601 theyear following tisaassasmtentdale,par addlHorral lnformatton on these and other benefits,please consult Indiana Code§§6.1.1-12 and6-1.1-20.4, Noted ThaSoles Disclosure Form is not an application far iba Homestead orany other relevantdeductlons,foran annually assessed mobile ormannfacmred home. - _ - - - - -"Cit:5`..✓t�'c' _ - �Y'."='-0':. - :�.v C:1*.is':^ __ .:ct5•c^^r..'2'tiY-4e:Cl:''>.: _>,r`4: _ :Y�. _ _ SY. u-=c;o.•::.�- - =r_a%;;;. ?:c;=;yp�t.� - - - ,T: ,{s::. - '•r:_ LI N :,1,•. ;s.-;•cr.r,> Asa =(::1:ct_w'[- ,sic;_ -`4P= .k':'•,. :. ....�.. ., - .�...,+-:...,v ... ...-.�. ,•,:. ..4...?�:. _ pH0 -•.0 M�N�ti'.tYl OT Qp� c.o .i ry ..�.. _:l•.-.�a.,-'�j.: .!f'(C(� -�y.Y' .n 1.:.f'.... .k..,..��`•�`a:c�}k'r;Lw,..._x w:Y:S>,i':,"r_d. -��::"� _i:n:..Y.,•:•';�•�_il'�-.. ..'�n1]t,:�F��-�....,;.L�tii:� - .�n1�......�151t.� h1,•;,-.;72.r p..s-..Q�N,.ti, -:Y."x:ss..��£:t4:_,�..,ax-1�=i���.- 4 �,?.•"•sic'=r�>vi;: ,::t.:�i..,.;�,,:s6:1 5�� ..�,- ...,:stip:K' - ,.5. =.,,ii:q Indlada`Co4e.'a:+a.`<i;;l�=•.?'�.-•:�.>=- -,Lar�:..4..,:,-5�:•:a=aSF.:;��SL[Gle1L1TY.ne VIRB61HN1St::�±�,:_�yz�'�.s'.�.:;<s�r-.1;:�-. - +�`3';••Re tnttDD�.,�a- z._.,y,.`�'�`�'O'�ucrloNs!��' 1)Residential real property Improvements Unclndinga house nrgaralie)located In Indiana that an individual uses asthe Indtvidual'sprincipal residence,Including a mobile ormanufacmred home notassessed as not property; The lesser of: 2)On the assessmentdate(March 1,or In the case ofa mobile being that is assessed as (I)slxtypercent personal property,the tmmediatelyfo0mvinglanuary 15]orony date la the same year Sales Disclosure Form 46021 or (6016)ofthe afteran asressmentdate,the Individual orentity owns;Isbuybrg undara caotracttbat DLGF Form 11C10(State Form Homestead Standard assessedvalueoflho providesthat the individual Is topay the property taxer,Isentitied to occupyasa 5473),One form filed for both the Deduction real roer or tdnontstoehholderofacoup era live housing corporation;orIsantndividualas tf-mosteodStand ard➢eduelion p p n dosathPAInIC6.11-12-17.9 and the resl5tenmisowned b atrustasdescribedinIC (5-1,142-371 (2]forty nva y and Supplemental Homestead thousand dollars 6.1.1-12-179; Dednctlon. (S45,000). 3)Consists of dlvellingand,not estate not to exceed oceacres irroundIng the dwelling; 4)Ona standard deduction per married couple erindlvldual. Note:Homestead does notfnrfuda propertyamned Lyu corporation,partnership,limited Pub9irycommry,por on(fly not deserlbed In IC 6-1.1-12.37. Equal to the Sum of the Following: (1]thirty-oro perceat(354o)of the Thisdeduction mustnothe Supplemental Homestead assessedvaluethatfs considered ht applylog Use DeductionAn Individual who Is entitled m a homestead standard deduction from the assessed value Sales Disclosure Farm 46021 or Iris than six hundred limits In IC 6-1.1-12-40.5. thousand dollars oeductifluroperlyunderIC iaassesedivaue2-37 so ort a homed to steadtolvoesuhe standar homestead DLGppon.HC30(State Farm which states that The nun of 2009andanJamsa[yt. 600,000• daductionfiramtbaassessedvalueofthohomesteadtowNchthestaadar4deduction 5M173}.Ono formfiledfarboththe 2009 and applies to (S ) appllesafter the application ortl.o standard deduction buthefere theappticalion ofaoy Ifamoctead Standard Deduction an annually assessed mo it property tares first due (23 tweury-fiva otluardeductioa,exemptlo%oreceditforwhicb theindlvldual lsellgible. .andSupplemental Homestead an annually assosaed mobile In2009amttharuafter.) percent(29%)afthe Deduction, homemrmaonfachtredhome (G-1.1.12-375) assessed value thatis may tint exceed one-half more Chan slit (1/2]of Itx assessed value, hundredthousand dollars($600,000). •Any unused portion oRerappUcatlan to residence property applies nonce personal propertyand lastlyas Excise Tax Credlt on elthat malar vahlela miss tax(IC 6.6.5-51 oraircraftlIcense tax(IC 6-6-6.5). 4,'The sum ofthe deductlonsprovlded to amobile home or m a manufactured boma that is not assessed as real propertymaynot exceed one-helf(1/2]of thu ossessed value ofthe mobile Immo or manufachved hone.(IC 6-11-12.405) i INDIANASALESRISCLOSUI[I VORMINSTRUCTIONS Page 6 --.h:ti �_'G::i n:r+-: - ir.1G. - u.4 r w5`.?Y.z.. � �4'" a31r• -..moi''`.`!-� ':.^.::4.+�•`sYi_:-_ - ' _ ,�J,t�fy1,... •,.,�' ,t. - - „�Y" .,t•.�.,fi:� .�?sr>.� =�,��;SSM:'• _..N- „f!IL.,:�Y: ..�!!�?..::...:_..,..,.N,!'s^. .•,D1tpnGYl� "- ..;�i.MAXIM tVI'��Q. 0'•a�:Y�':-�,;:ry:;:�_.:?rYa•'•,.j: - - 2e - -_ .'„t- g,—..r_ .���5 r.:a.;-1, ua - -- Gt'B 1 N7S':. : x=�z' ,a`4.Jm:<::J�S, ',at; :;e v,.:ac,rc•. — —�: ,„kS :; }c< ,. k CTk'R8. A�. k;r y_ g/)1t1a"ai:ode,,:}«..� a.-� �' •'e .au„�:h`G...•: - :gal z-. sr.. :. w;t„ x.....x.:�s�;9> :.tY'^ xf.a•.:,,h... ,.aeM..,, ,,,4.. `o.'rk;tz°:sJQ � ' =T1 .��,-.�.a�.;}'•:-:'saz."'�•u:-R:,.�_:_...�.at Lnit:.ittYn`:=i`.��.`•.'t`?i':e.Gn`.'1-�x�..c!.�..:v'�.�::�:&.L:r.. =�itSRE dmEO.c'.'.`-3 s.S�Si.•�.a;• �gDDCT10NSie�'Z„�� Solar:Sales Disclosure-Form 46021 orStatc Form 18B6S W IndtSalus Disclosure Form Solar Energy Heating or Deduction equals the 46021or5tate,Form 1006S CoolingSyslams out-af-pocket flydrael-wicts.6sDisdosum [6-IS-12-2b) expensesifsabluctle Form 46021orSt4W-Farm assessmuni And 189651and taxation. II Person Must own orbs buying an contra tthe real property or mobile or manufactured hommnatessessrd as real propertyon the datetheapplicatfon ental is filed: fndlanabaof HnvlronmntalbiFfanagement 2)Heal propertyormoblle home notassessed as real properly is equipped tvithasolar (IDEM)certificaulm,whIchmay PARTWIY-These unorgysystem,ivindpotverdevtx,bydmelceMlcpowardevice,orgeotbermaleuergy beobtalnedbymailingcopy of deductions may beclaimed heatingorcualing davloe; State Form to IDOM,100 N. with all other dcduufons 3)Will respect to real property,file during th a year for which the pers o n desires to Salida Ave,Indianapolis,IN EXCEPT11ho0ver65 obtain tha deductlat4 and with respectta mobile ham which Is not assessed as real 46204 Dedadtan. Wind Potver Device property Me during the twelve months before March 31 ofeachyearfor which the Geothermalt Sales Disclosure dallactionIssought[ifmailedthemallingmustbepostmarkedoilarbeforethelastday Form,16021orStatePocm1e06S (6-Lt-12-29) far filing). Indiana Department of Ilydmeledde Potvor Deduction.equals the Environmental Management Device assessed value oftho [IDHM)eorlificatimulvbtdtmay (6-I.1--12-33) device, be obtained by mailing copy of stamForm to ftirm ip0 N. Geothermal bevlca SenateAve,Office of Water [6-I.1-1234) Quality.6540 Geothermal, Indianapolls,IN 46204 I S i i INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Pnge 7 TAWZ—OtherDeductlans NOT covered under the Soles Disclosure Form Usled below ate certain deductions and credits that are avallable to IoW er property taxes in fndfana.Taxpayas say claim these benefits by fling an application with the Auditorin the county where the property Is situated,The mortgage deduction upplicatlen also may beliledrrith the Reeordorin the County whera tho property issituated.The previous taxIALLwill facgitate iMng,but it is not required. Applications far daductians agalnstreal prapeltymustbe Bled during flmyear In which the deduction is sought to he effective for taxes payable In the followingyear.The filing deadline for deduction applications far mobllehomes and manufactured homesthatare not osgessed as realproperty is the twelve months baforo Dlareh 31,unless noted below. The deduction will appear on the tasblR thayear follocrfng the assossmantdata.Foradditlonsl infmusatIon on these and otherbenefits,please consult Indiana Cade$§6.1.1-12 and 6-1.1.20.9. Notes The Sales Disclosure Farm Is notan application for the ttomestead,or any otherrelevantdedactions foran annually assessed mobile ormanufachlred Ionto. " .,etc:'.-moi ;.:.r.':. a..: :e_c - - y>xn.n -�:1i;'+.=�. r1•t�,,'_�. __ -+'t��z:�' _ _ _ _..-�,..�. � �z•�, lu Yr:.:- N>`:.s $'-..w.#,..,.st..1 :;:i,:.F:� 2�n�t w�; '.j. ru+��..Np:s t.® R 4 1 N N& i Vit: = r ? 4t! 1 J ..9N '. _ :a.. ULs'f f�fAXi pn,�# ,it FIrJi�s3 i50[?};_mss NI -SY_TOT. i .ter q,A�Ql. =�g -�! '�h--u.N,���.2.n`v3Y;�±. �•>,t•..; �-+�:.-�.t 7Yar- �2� ���'t?� aL�i+=---'O-*'�=�-�:;.;.�r �...�,v...:.���.�.�;.� `y:lisSlan�Gado,v;u_ „`.>�::-� := �f}ICMD S=i3.- 1_•s.: >.___ ..___,•rasit?'ftR timriD.:?�-c:=-� ilRpsf- aN� �:.-:,;:��: 13 Person must be resident of lndlanas Z)Porsonmustown of bebuying on contract the real property ormeblle or manufactured 4lsolesscrof• bomepotassessedasrealproperty onthe date the appllcattanIsflied, State Foran 43709 M$3.000. 3)Propertylarated In i,dianas 4)person owes a debtsecurad by a mortisageor recorded contractan the reai property or ApplIntions may be filed with (2)amuuntoflnoblieormanafeoluredhamouotessessedasveal propertywhlchprovides thatthe cttherthe Auditor orRemrderin Mortgage mortgage or contract contractbu rlsto a the roe taxes, the County where thepropertyis Ya pay property ttS' Nona 6.1.1-12.1 indebtedness on sitnated. ( ) assessm-stdateof 5)Withrespect tareal property,fitadmingthe yearfor tuhlchthapersondesinsto thatyeatinr obtain the deduction,and with respoettomobBoormanufacturedhomes notassessad Nn{orAnotVopplleatlanmwstbe i (3)onetnlF(1/2Joi anreal property,file during the twelve montllsbefore March 31ofeach year for whicls Bledsvhenevoraloanonreal lino LOWi assoSSad the deduction issought(lfmaBed the malting must be postmarked on or before Umlast estateJsreBnanted. day far 0rng); value. 6)Contrac tbuyer must submit copy ofesemomse um Ortho recorded contract,cantnfiing a legal description with Ilse firstetatemeatfded underthlsdeduction. INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 0 ��.- r �: a -o::a>.> -�': :;�c_+'.x,cr•.s.j -iy Vii,.: _c_. -'cv.., �.?Frxv_'°�J•k:: tit= H 1 I0 $ 0 5 ` r r { a4c ¢ y. b e 55t1Y mR»TI[Z (- i== k U fi r,` d nrlA l � � � ' Wr' a � K1 � f p 3`cotes ININ 7 BEt p T.; vr�fs€� u zea at aew _ ?fa, F.y,._! ..• P fx �. i t 7r?� rife e:L�a a ,:err. �=-esti-•� t_�ti Wiz,..:.- .::� L•iGi6 l R>;�`'ilt6lt);f�S;,��.. — .-�, - �:`•>,-uat�.—.-:ittF. N1AHO.tn'%.,c:.s`�`Y- EP1��bN5li. 1)Individual mustown or he byyingon coutractibe real property armobtla or manufactured home notassessed as realpropertyon the date Ihoapplication is filed; 2)Indlvldual is allamt 65 by December 31 of the year preceding theyearin which the $12,480 deducttonisdalmed; 3)Indlvfdualrestdesoattherealpropertyarmobtlehomeormatinfacluredhome; Sbteft m43708 4)Combined adjusted gross Income not axceeding$25,000; InteroalRevenue5ervire Porta f4olnisortena Irall Vildlvldualharawncdthereal roe ormobilehomeormuhufecturedhomoforat 1040 for the previous anydedmcdons other rthan im Over65 tenantrortmanLv(n i P p the Mauagmaotherthan camraon erenat at leutona(1J yearbehie claiming the deduction; year. the Ma 6.1.1-12.9 teed 13-4 d the ( ) lonit65 caaofa 6 Assessed roe value not exceeding$182,430; 19ds requ'ntment Includes Y gS ) property rty g submitlfng lila 1040 for the Homestead Pedgctlous. thedeductlon 7)Survlvtng.nn-remartlad spouse at least 60 years ofagelfdecaesed was 65 atthe time allowed shall be ofdeathl appllcantaudallro•otmets reduced. 8)Individual may not he denied the deducHahbecausethe Individual is absent from the real property or mobile home or manufactured home While In a nursinghoma or hespitat. 1)Individual isblind as defined In IC lZ•7•Z•21(1); 2)The realproperty or mobile or manufactured home is principally used and oceupled by the Indivldualos the Individual's resldrncel 3)Indivldual must awn orbabuytngou contracrthe real propettyarnneWeor PARTIALLY-There Blind manufactured home notassessed as real property anthedatethe application IsDied; StatoForm43710 deductions may be claimed 6-f,1-12-11112 $12,480 4 Individual's taxable gross lnmme doesnorexceed$17,000; with all athar dcduc0ums ( ) ) g PrnafafBindness 5)W1th respeato,real properly,Ale during theyear for which the person desires to BXGEPT the Over 65 obtain the deduclfoa,and with re3pectto mobie or mangfactured homes notassessed Deduction. as real property,file duringthe twelve monthsbefore March 31 oreach year for which the deduction Is sought(ifmailed themaillug must be postmarked on orbefore the last dayfotfiling). 11 Individual qualified forhomosisadstandard daductiou In precedlogmlendaryearand qualifies fn uurentyear, 2)liar Individual who files single return,adjusted grosslncomn cannot exceed$3x;000, forindividualwha files a lolnt roturn Wth spouse,udjusted gross hicome cannotexceed $40.000; 3)Homestead qualifies asa'quallfied homestcadproperty'fortho culcadaryear and filingrequtremeuts are met. moans the Individual over 69CImuIl6reaker Tasliability minus who away,is purchasing the homestead an contract orhasbeneficial interestinthe State rui'm43700 Credit the productof tax for owner,is orwill beatiout65anarbaforafiecember3lofthecalendaryear Internal IteveaueService Form (6LI-Z0.6-8,5) preeeding year huniedlatelyprecedfng thecalendaryearinwhlch the taxes are duo,aml ilia gross lo4aforthe prevtauscalendar None multipliedby1.02, assessadvalueofehe homestead ontheassessmeat date Isles than$10,000.1 year farappicant and spouse. 4)With respect to real proDeny,file during the year for which dm person destras to obtain ilia credit,and with respect to mobile or manufactured homes not assessed as real pmparty,Die during ilio twelve months before March 31 of eadryearferwhich the credit Is sought(Ifmallcd ilia mallingmust be postmarked on orbafore the Jut day for filing); 5)pile In same manneras for 6-1.1-12.9(over 65 deduetioril 6)Appllrs to taxes firstdue and payable In 2009. INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Page 9 3x� .er.' `moo -..v�;.'v.'N"`�.•"•..' tw_.eY r.,t ,y � '':— a,r .•oy'Y-.i:��.fTs" c." '_.,— .r_ "`z-_ .-��-� � 1tiIP_ -- .zyyyL`T)0 �.•�-,q `��'.'..�. / '•�x `''w `�'�.� rte" -`-Y.zy.; �c `s `r'�' ca'• r, rfy� d Re �,'k"�-*3�u`v`'.-r�•w 3. ",L3-;t_- 3.cL.5;.+.b v}r.'�'�"i ? ?E ILI]Y•'RE UI1 FMT$ �:"?.a.�:e::t`fi%n':?osis �..c`-,sti�'.'r"r.».'{RL TJ Bd` k,ys#'• "` IUU. 0 1)Anlndividual is'disabled'Ifhe is unable to engage In any substantial galnitlactivityby reason ofa medically determinable physical ormental Impairment which can be StatePonn437]0 ekpectedtoresult lndeath orhoslastadoranbuexpected lohistroracontinuous ProofofDisablll period of not less than 12 months, tyr pruofthat a abireceive 2 Thereat property or mobtleormanuracturad homois rincf aIIyusodand occupiedby dslillybenefits under PARTIALLY the individual helndlvldualsresidence, fedmlSclItSecurity Act daductions may be claimedAlsablcd 3)lndlvldual must own or be buying oncontract the real property or mobile or rorsUtutesproof far purposes of$12,4E0 (6.1.1.12.11;12] in anufacia red he me notassessed as real property an the date tho.appi ItAtion is med: lhtssectlamhowovenau tvlUrall Other deduUlons 4)Indivldualstasablegross incomedoesnot erceed$17,0001 Indlvldualsvlthadisabliltynot so eXCEPYthe0aer65 coveredrtmsthe-examtnedbya DMuctloR 5]With respect to real property,file during lhoyearfor which the person d°simsw physician Oodor the saine obtain the deduction,and with respect tvmoblie.ormanufacture dhomvsnaRAN ssed standards asused bysocial as real property,Maduring the hvetvamonths before March 33 Ofaadtyearfor which Security Administration, deduction Is sought pfmalted tha malting must be postmarked on or before the last dayforfiling), 1)Individual must Own or be buying on contract the real property or mobile or manufactured home notassessed as real property an the date Ibe application is Wadi ' 2)IudlvJd net served in O.Smilltaryservfce far at least 90 days aadwas honorably discharged; State Porm 12662 3)Individual Is elthertatailly disabled or atleast age 62 withatleast 10%disability; MtberVAparm20.5455Code I PARTIALLY-These Disabled Valenti • 4)Assessadvalueoflndlvldual'stonglblopropartylsnotgroaterthan$143,160: In Item 1115;Pension Certificate. deductlonsmayboclaimed 6.1.1-12da 15 S�AEO Awardol'CompenraUonfromVA with all otherdeducctons ( I ) b)With respect[arealproperty,Me during theyear forwhich theperson desire ro or DOD;or Cepanyto of EXCEPT the Over GS obtain tire deducttotyandwith respectmmoblleormanuracturedhamesnatassessed orgOD;oibility fcomlNatu,of VA EXCEP th as realproperty,file during thativelva months before Match 31 of oachyaar Cortvhleh n. the deduction Is soughtaf malted the malting mustbe postmarked on or before the last day[a r it]in g); 6)Survlving spouso may appTy If the Individual would qualify Ifallve. 1)Individual mustown or he buying an contract the real property ormobilror manufactured home notassessed as real property on the date the application Is Modr 2)Individual received an honorable discharge aRerservhrg In U.S.mtDtasyornaval farces duringany ofits soars; State Form 12662 PARTIALLY-This deduction Veteran with Service 3)Individual has service connected disabilltyofatleastl(%: SrtberVA Farm 211-5455 Code 2 may he claimed with all other Connected $24,960• In Item U ISI Pension Cortigato; doductlmts ERCEPTthe Over 4)With Award ofCompensatlonfrom VA 65 Deduction and Surviving (6.1,1.12.13J15) obtain the deduction,and with respectio mobile ormanufaclared homes net assessed at DOD;or Certificate of Spouse ofWW l Vale= at realproperty,fit*duringthe tivelvemonthr before March 32 cfeackyewriar which ollgibillty(r°m IN Dept of VA, Deduction, the deduction Is sought(ifmalledtho maRing must be postmarked on orbefore the last dayforfding); S)Survlvingspoutomay apply if the Individual would goallfylfallv4 E t : c INDIANA SALES DISCLOSURE FORM INSTRUCTIONS Pe e10 'ri ,- a, r, " .n__ - �� pPLf• 3 ,-<�.'+',a;sY1CSfiR( IU S{v) ':c .,:- - c�. 'z;sY``s Tr`} #zK _ �-y-• .7 Fti,.na _.c.. `c.:.� t6luits°Hsi1u S� '<?a; s ;� ,.s '`i - � :Y T[o o TIN tNt Ji.-rl-im 1i g .• -.-fiD- '>-=:-� ',�'. ;?fix: '='"q---_..ate' ,-.�3: �'7 ' - �[ 6L1G1�1-�LIh1iA�Q • 1)Individual mustown or be buying on contract the real propertyormob0e or manufactured liame notassessed as real property an the data the oppllcationts I led; 2)Tndivldaai mast be resldentof indiana; 3)property musthe theveteran's prindpal residence; 4 Individual isa Veteran ofWarldWarl; Lette hmiVA or maybePARTIOalmad isth all other on Veteran{Yarld{Yost t10,720� ) LetterfmmVA ar Deportment of maybe claimed tvlth all atlrec (G•11-i2-17.4) 5)Assessed value oftheresldencupropettydoesnotexceed5206,5001 Dafensror0ischarge deditctfon3EXCEPT the Over 6)Veteran owns the real property ormoblle home or manuferiuredhome for atieastono Documents. 65Deducttao. yearprlar to datming deduction; 7)Individual may tratbo denied thedeductionbecause the individual Is absent from the real property orniobllehome ormanufacturcd home while In a nursing bome or hospital. 1)Svrvlvmgspouse mustmva Orbe buyingen contract the real property armoblle or manufactaradlome net assessed usmal property on thadato thoappllmtionisfiled; 2)Individual Is spouse ofdamnsed person who served in the US.milimry before PARTIALLY-This deduction surviving spousoor Aovomber12,1910; State rorsn12662 may be claimed vdth all other World War[Veteran $10,720' 3)Deceased spouse raralVCA an honorable discharge[ LetterfrnmVA orAoperiment of dadactlons EXCEPT the Over (6-1.1-12-16;17) 4)Wlthrecpecttomat property,file duringthoyearfortvhidlthopersondeskesto Defense:orlilscharge 69DedudlonandVataran obtain the deductloMandwith respecttamobpaarmanufacluredhomes notasseued Documents. wlthSerAceConnected as real property,Dia di ringthe twelve mombsbefore March 31 of eachyearfor which Disability. the deduction is sought(if tnallud the inalling mustbe postmarked on or before the Inst dap for thing), •Any unnsed portion aitvrapplieatlon to residence propertyapplies nexEtopetxnbnT prnpertyand.fully as RxelseTax Credit on eithermotarvebiclu exeke tar(IC 6.6.5.5)or aircraft license tax(IC 6.6.6S) "The son oftim deductions provided toa mnblle bome or ma manuractmedhome that[s net assessed as real property masynotexceed one-half(I/2)bribe assessed value of the mobile homo ormanufactvred name.([C 6.1.1.12.40.5) Spedgcdeduetlan claim forms arc avallablefrom the countyauditor or on the Indiana Department of Loral Government I•inance wohslto:hum:lhw.nv.lu.gnvflcttr/we6RleJlermsdly/2[t97.htret.