Homestead_Herrin (2)� CLAIM FOR HOMESTEAD PROPERTY'TAX : �
' CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R6 / 4-03)
Prescrib�d by the Department ol Local Govemment Finznce
INSTRUCTIONS: See reverse side lor liling insbuclions.
- - -�a�- --FORM'- -
— HC10
s
YEAR._ _
� M�e) _I�A�,Lw_iC.�.l1i JVY\ (o �LQ��,e`1 � certify that�athe ]�t a�.ef�M�cb/zs�..�
I(VJe) occupied as our principal place of residence the following described real property for which a Homestead Property T CC` it is herebx daimed:
�� I(We) owned ❑ Ne buying under contract � '`� � L� O F) ZUO4
' Have a benefidal interest in the en6ty that is liable for the property Uxes on �he property and that owns �he proD9�W or is buyingpnd�a contrast.
If buying om m�trau, Fee Simple owner's name
where contrad is recorded
Caunry
To.mship
Tacing
Record number � Page
r;(Fei1 yp�cer ,y L� ,�_• _'� I �ega�sc � ^� � I Is the property in 9uestion:
r��� r9 c!T�r�U�tl r I
�..� "l lJl/ l Ol �/ CX ❑ Real DwPeM ❑ nwaie nano Ii.e. s�. i-n
If any portiw� of iha rasidential swcture w the land nat escceding one (1) acre that immeGiately surrountls Nat stiucture k use0 to produce income, tlesaibe Ne use and portlon
ot Ne propery utiiized to produce inwme.
at. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
"' i�f�`' STANDARD/SUPPLEMENTAL DEDUCTION FORM
y_'` State Form 5473(R13/12-09) HC10
`r.." Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
fi.-y f tt .. ...t {r :r '4 -y' Z`# r a Zl di g' LL y67is1?C�m afit ° rt ." :."
.s,_..�} .3 .i+l..�,,i _a 1 ,....'v»�yt:r�..o�3.+z rz�r.'�'1'6r CERTIF,ICATION;STATEMENT�� ;4"zr 1.}: '-. �,q�. 3+um '�.?,i .e� .. :?z-
I(We) : ./ /_ - i o ! I ' 1 ail(we)tT''. . T)my(our)principal
place of residence or am(are)buying the folio+{g described real property for which a Homestead P ..- j 'r".a : s--..�i on is hereby claimed
er contract on the date this application is fit=., (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract APR 2 5'2013
U Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation //����
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified. j trust
•
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
2zc_ s -.: .`. z +. y ".-,w .ISkanR+fCLAMANTS INORMAON, y :``r'.'2 uA�zsRc,t.i.."xc -ziir_fr.... " :=`a f
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Name of.+ t(legal name) r , lJ_/ c
Name of claimant's spouse(legal name)
Social Security number of claimant's spouse(last live digits) Driver's license/Identification I Other number Issuing State
of claimant's spouse(last five digits)
tt.r3TW._i. .1a.,f .k7S..iw,.c .fir". i.r_�u'-11++CONTRACT RECORDED'�lix.}ems -z..a.i ::.;3fiagSr{.. A4... ._. . e3a,.`.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
rLiS iy4,W f 7 1 P-'--a 1'`V,�' -•t' w.,:��. .IIFROPERTY'DESCRIP.TION,.3i.`�lt�tRE n.x 4iga:.2Y..?. ., a.',iFi^'"_,1'-r... .`::
Count/ /9 / 7r> I Taxing disf�(cityi town,township)
ad 090
Pa'/./ mber ,p Legal description Is the in question:
EX—/0S -/C — 0a - 00 . /6/—Oa 2 Real property ❑ Annually assessed mobile home(lC 6-1./-7)
EX any portion of the residential structure or the land not exceeding one(1)acre that Immediately surtou dsfi that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
, ...-14. ,f%. ;" . , n R,?-?E- nt;" ,f`ggTPROPERTY'OWNED'BY'C Min ANT IN OTHER{COUNTIES?jyt-re Ktxf447.:y%"t ,,, 4,`j:
County Township County Township
I hereby certify the above statements are taste,correct and complete. Signature of claimant
Address(number and street,city,state,and ZIP code)
-'. a-" '' s '` 'l "' " r's' -X.,-� r ASSESSED VALUE - ^HOMESTEAD{ t '; NON RESIDENTIAL-r. '°A
bj+z? .. C ASSESSOR USE ONLY t �3--}`BTRUE TA%VALUE I -� - x I s :i:F.
-4 ,.u."_. .•.r .. , . i S'1:11a.:1..frr. . _ iikX,4::.._.. ATA100%-OF LTV-) a�a.sVALUE aYa ,. .. -f1_.zi,VACDE.tc.a. -fir.-
Land not exceeding 1(one)acre Immediately i 4 tt`f z 1f'11y
surrounding residential Improvements. (1) a . :i C
:-'2'^y:F'cite;*;.:*
Other land (2) e,-.it3 ,; t"
Total land(line I plus line 2) (3)
s� a
Dwelling (4) yg. ..ai a. ..h. +ct.
Residential Improvements or Annually
Assessed Mobile/Manufactured Home n - >---:Y` ° #
Garage (5) va _,,. v sA,
_ ,`.-fs .
t ur `I ±x.4Ij.r
Other Improvements (6) � .°;,:
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Date signed month,day,
I hereby certify the above Is true,correct, Signature of Assessor g ( Y year)
and complete.
Vedyi g action-Signature of Auditor Date signed(month,day,year)
fAt w.,+5.,i,`4e:V,Z'�� ilf. o f,M-.51:. :S'ii<41.:7::STANDARO DE out TION'ALLOWANCEa;tT _..,2..'..i ti_i,�i.i:4;:i*fpa:-I a.*k1 aiii:w.0. .6 M
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 8.1.1-12 to a mobile home that is $ r�
not assessed as reel property or to a manufactured home that is not assessed as real property may not exceed \
one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)