Homestead_Conley (3)^�n
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
State Form 5473 (R12 / 6-09)
Preuribed by tha Departmenl of Laal Government Fir�a�xe
FORM
HC10
YEAR
INSTRUCTIONS: See reverse sidelorfil'ug ins(rucfions. "
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� (We) ceniy ih�( �(�) �i�iY (our) prindpal
place of residence or am (are) 6uyi e tollowing described real property tor whirh a Homestead Property Tax Standard Deduaion is hereby daimed
under conVacl on the date Nis appl n is filed, (dafe offiling): �� ��
❑ I(We) own Am (are) buying under recorded conVact
❑ Am (are) entilled to occup as a tenant-stockholCer of a cooperative housing corporation GIBSON COUNTY AUDITOR
� Have a benefidal interes[ in Ne trusl or the right to occupy Ihe pmperty under the tertns of a qualified personal residence W st
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Narne of tlaimant (kgal name)
So�l Se¢uily wrriba Orivefs fuxnse / ICeniification /
Name o( dairtanYs spasse (legel neme)
Sodal Seairiry number of tlaimant's spouse (last five dg'rts) Dmmfs tirense / MenGfiralion I Olhe� number Issu'ug 5ata
of daimanYs spouse (Ws! frve digiGCJ
• ••� �
tl buy�ng am m�trad, Fee Simp ownels `wne
ReooNefs oi6ce wMre mntrad is r Remrtl number Page
"'�. . � . �
�nry Township Taring tlistrict (cify, rown, fownship)
ParcnJ number Legal Aest>ipUon Is Ui properry in Queslion:
' Real propnrty ❑ MnuaAy assessed mobfle fnme (IC 6-f. f-n
�if anY Po� ���e�e��l swcaue or Ne land nat exceedi`g me (/) aae ediately w tls Nat siructure is useU tu produce irKane. Cescnbe the use anE pation
ol Ne pmpeny uol'¢ed tn pmduce income.
�G-/�-l�� /oa-�. Ga-a� �9�o35a�
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Counry Township Counry Township
I hereby certity the above statements are we, correU and complete. Siy ot aimant �
ress number an0 t, My, state, antl L cade
b 1.�. � ` `Y�C� �F
. . .. . - �
.- .
�� ..
land not exceeding 1(one) acre immediatety � �,r,?i i'��-�;� ����� ��;
surroundin residentialim rovements. � %
ONer land 2 "'��';'::���'�"C
i ) C:.e_,r.s'-�:?Fu.t.r..
Total land (line 1 plus line 2) (3)
Dwellin 4 3'an��-+a-';;--t'�n`,. � �F'�.. rs;i!
Residentlal impravemenLV or Annualty 9 � � - � � �' �"` � ��' '�'s'' �x
Assessetl Mobile I Manufactured Home Garsge (5� zL.:�m> rt y"'���� �'��"x'
x �.x. 'fy'.�`+"*:.zzt%E3 .ct�_'n...F.
Other improvemenss (6) „>'k ;af`L `i =�y
Tatal impravements (llne 0 Nroug� line � (7)
Total value (Ilne 3 pl�a Ilne n (8)
I hereby certity the above is true, cortect, Sigiature otwssessor oa!e signea (montn, dey. yra�
and complete.
Vvitying erlion - SignaW ie of Nidtor Date signed (rtronN, day, yra�
�.-� � � • •
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45.000
NohWMStaMing sny otherprovicion, Ne s�on W Ne ded1¢tiont prori0etl in IC 67.1-12 to a mobBe fame Nal is g
rwt assessed es real properry w to e manuFaGUred hane Nat is not essessed as ieal pmperly mey rrot exceeC ' - - '
me-haH(f2� W Ne assessed value of Ne moE➢e home ar manutarturetl home.
59nature of PudUn Date signeE (monN. tlaY. lTa�
� Gibson County Auditor
101 N Main
r� PRINCETON IN 47670
J�
2438
fT�R!!MM ��!MI0.:/vWl
1RfAW AF0. Po0.4 S�IA
InJi.�iduab and marriN mupke are IimitN io one homeucaJ uandaN dNuninn. As �he rttcip� o( this dNuciwn Mcome�
mure beneficial, iherc is morc incrntive dun e�er (or home:te:wl Fnud IlomesieaJ tmud causes higher tac bills tur all: Iherefwr.
HEA 13d3-7(1(19 rcqvvrs uspa�cn who reccivc Ihc hanesmaJ smndard dcluction to .eriH ihat thc} are elfciMe w rttci.r �he
benefii anJ to p�m'idr adAitioml identityin_ infwmatiun Mcc:'vn� ro allw' counrc ernemmmt ro b:ner muniror homcaeaJ
filimn _ 7Lis inlamu�im will M Aryv crnf.Jrniial anA can nnlr M amc. �nl M1y amhorind rnunly nfl'miaL.'ffit IkTannmm o(
Lacal Govcmrn<m Fi�u�wc will u.c this iniofmation ro crcau twis that x'ill h:Ip camty ofTicial> clfmuum M�mcsmad fraud.
� � � � � �
T��parer Namr Prooert�• Address
Conley, Henry T
ro �3ox 3
re�on IR 47670
Henry T Conley
4184 Maple St.
RICHLAND IN 47634-9435
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State Parcel Number Leeal Description
� 26-12-07-102-000.462-028 D1a00a62-OOO���PLAn725PT
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