Homestead_Otake.,.
, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Sute Fwm 5473 (R6 / 4-03)
Prescribetl by Ihe Department of Local Govemmenl Finance
INSTRUCTIONS: See reverse side loi liling insfn�ctians.
FORM
HC10
YEAR
��e) —�1��—� �i��� �!—�—'-�1�. c��dl�, tt�t� R{d`i 3t day of March, 20_
I(We) occupied as our principal place oi residence the following described real property for which a Homestead PropertyiT�c Credi is "reby daimed:
❑ I(We) owned ❑!ve buying under contract /�[�,+�
� Have a benefidal interest in ihe enti that is liable for the m e taxes on ihe ro e and tha(,ovms the, �o J� ��"Tr' '
�Y P P rtY P P rty p perty or is�twying under a contract.
/� GiBSv;••• �_
Ir buyirg on conVaa. Fee simple owners name
RecorCefs ofice
If any poNm
of Ne wooerl
recorCed
Twnship
�
Is Ihe
sWCWre or Ne tand nd exceetling one (7) aae that immedialely surrounds
Ke i�ome.
v��e
Rewrd number � Page
❑ Alabila Homo (I.C. b1.7-n
Is used to produce income, desaiba the use and ponbn
������ i
� xiAS�SE OR I1S�E NLY�;, ��i° � �' p�TRU N(�-�. ASSESSED VALUE a HOMESTEA� � NNO�RESIOEMTIALr.�y:#.n
-�,s-�+qs, r,y�Fy :,�:���,.?�.��` _'�,.� ���,w�_VACUE��7.,,�i. �,�ATc100%'OF�TFN� �?�r�fi;VALUE�' ,� ����VALUE�'��
Land not exceeding 1(one) acre immedialety �'7�`" r ��*^
`.�,5`�� ` " �' "�`��
surtounding residential improvemenis. (�) ��t �°3"'0 '� �3 ' Y:. � '
.�...'X:� '�`'c:r �.'z�
Other land (2) _�� %�''�� Y .
F
,.F�x��:�s`S.- --
Total land (line 1 plus line 2) (3)
s �r��� -���
Dwelling (4) �� �" +t .s, c�.
Residentiel improvements or Mnua�y ��aF"""''A`-'� �"�' ��
0.ssessed Mobile / Manufadured Hrnrre Gara e �����--�^^�`�,•-,� " .. .a:
9 (5) �r�.�w i '�1%�5����n�����
�'�t.�,�a'� -
e4'J.- G
Other improvemenls (6) �z�, �:. ��
-- `'�t;'�;�� ' .t
TUaI improvements (line 4 through line 6) (��
Rtal value (line 3 plis line n (g�
I hereby certify fhe above is We, coned, and Sgnamre of Assessor Data signed
complete.
Verif9ing acl"nm - Signature oflwdimr Date signed
20_Pay20_
Lesserof 1/2 Homestead
vewanon or E35.000
signetl
Gibson County Auditor
101 N Main
PRINCETON IN 47670
�
tUiElOFN!!'Mltit��Ml
Rt�SIIIG fU0.Y ZIA
IndividuaL anJ marrieJ mupk. arc limimd to nrc homc.,tm� �andaN J�duc�ion. As ihe rtteip� ni �hi>'dalunan bmome� •
murc bem�ficial, ihrrc is morr incrncne than r�'er fur homa�exl G,mJ. I lonx.xml fraud causes higher tm b'lls' fur all; Iherefore.
HEA 13a-1-?I%N) requim bipacen who receire ihe heenesieed >ianduJ JNuction m.erify �hai �he} are e�ieiMe �o recene �he
benen� aml w pnaide :xkliiional identifyina infum�a�wn necreun� ro allw� counry gm'emmrni �o berte monitur humesrc;d
filin�,-. Iliic inl'ormation will M Aery mnlidenual enA r,m only h. arcec¢A hy au�hnriecd counn� n(iici�,Js�'I'he Ikpanmen� nf
Local Gm'emmem Piiunce will u.e this iniormaeion W creau [ vls ihat x'ill help cwnn� officials dimmtrc huma�cad frauJ.
� � � � � � —
_ .' _ �
- Tatipnrer Namr � � - - � �Pronert�� Addretis _ -.
Otake, Shuichi I
1843
BRITTNEY L OTAKE
1128 S 200 W
PRINCETON IN 47670-9313
���u��ni�i��u�ui���n��i�in���n�i��i���u��i��n�i��ni�
Ki
Princeton 1\
State Parcel NumAer LeQal Descriplion
26-11-14-400-004.149-027 OOGOa14300 PT NW i E 14 2 11 7624 AC
D-�
V �
Ox'ner 1 First MidNe
�Ur rW-���-y LyNN�
�e Addm+(numbcr and svce[, ci�y, sm[e, and�ZlP codr)—" '� ' -—
11 Zg S. ?�U v.�. �rinCe_� I N 4�lo�c�
Social Security Numbn (laa 5 digits) Ihiver's Lice+��c/Sum ID Nmnber (lazt 5 digiB) Other (pleue
� �
Addrcss (Number anJ stree4 ���y. sta�e, and ZIP cak)
Stturirv Numbcr (lact 5
ID Nwnbcr (lut 5 dib�G) � OcM1cr (plcasc
��-ak�
a; propc:ry� adxc; . . .
Part 4
� S�me � property addres.
Pan 4
undersigned certifies, under penalry• of perjury•, that the abo�•e and foregoing infurmatiun is we and colrzct and that he or
�e the homestead siandard deduction on this propeny. Fach undersignzd also unders�ands �hat, by claiming additional hom
,iully, he or she may be liable for back taxes and substantial financial penalties.
�J'�/C� I....�...�.. (��
� )
tlfefble to
deductions