Homestead_Mayer (2)"' CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
- Slate Fortn 5473 (R13 N2-09)
� � Presaibed by lhe Department ot Local Gwemment Finaxe
INSTRUCTIONS: See ieverse slde /ar fiGng insWctions.
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FORM
HC10
1-
I(We) cenify�thet I_(we) oaup as ��our) prindpal
place af residence w a (are) buying the toilowin described real property fw i a Homestead Property Tax Standard Deduc6on is hereby daimed
unde� conVad on the date Nis application is filed, (date o7filing). I(We): NOV 2 ��I i2
� Own ❑ Am (are) buying under recorded conUact
� Am (are) entiUed to occupy as a tenanPSrockholder of a woperative housing wrporation `���m°""(���
❑ Have e benefidal interest in the wst or the rigAt to ocwpy the property under ihe terms of a qualified personal residence'trusJ •
❑ Am (are) the shareholder, partner or member of the entlty lhat owns the property. ��BSON COUNTY qUDITOR
•• • •
Name o( dalmanl ( I
$ooal $¢quily �wmhni d (
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• .•. .
If buying on coMract, Fee Simple owners name � � a
Recordels ofice where contrert is femrded Remrd numb� Paga
._�. . � . �
Counry Township Tarin9 distrirl (dry, rown. o shiD)
�number Legal desulption ts tha pioperty in Qucstion:
8 �+1��3co-cco.a 8 -025 ��,�,, ❑ �����a�����,.,-n
If airy portion of the 2sidential StruGUre w U�e land mt exceedi�g one (1) aae that immediately s�rtw Ihat sbucNre is used tn produm u�mrne. Ae".rn�ba �ha use and portion
of tlie propeny umzetl m pmduoa Income.
-�• • � c • �
Counry Township Counry Tamship
I hereby certify the ebove statemenLS are We, correct and complete. g"a� °t dalmant
� �� , �
Address (numberantl streef, tif}; sfa(e, aritl ZlPcoda)
d3 9 s o0 W , 3 ra+� 11-� Z'Iv ��-�l "7 C�
. . �. . .
�' • �� ..
Land na exceeding 1(orre) acre Immedlatey u"};� }f �s �.= x`�,. � Y.. �:�
surtounAln residential Im rovemerhs. � -�•'
(1) �•,...� _ ,`� .:'s_. . v :��?:`
� � ��� d�
Otherland (2) � � �'"`
7oml land (line f plus llrre � (3)
.� ;�7, .v.. -� s �_ ��
ResidentiallmprovemenfsorMnually �NBIIIn9 (4) «�_ � "r`'>.o-Y�`�y�C�%'�,��:
Assesaed Mobtle I Manulacwred Home �9e (5) � .�'��., �s '��`�a�5s�y ���.?�
� }"w��,
Other Improvements (6) � �x : � � - .
7otel improveme� (Itna I Mrough line � (7)
7ote1 value (Iine J plls llne 7) (8)
I hereby certity Ne above is true, cortect, �`�°1e °f'�s�5°� �� gg� ��N• �y, ��
and eomplete.
verifyc�p aawn - signawre ora,afmr oam sgnea (mrnm, der� Y��)
�.•� � � • •
20 _ pay 20 _ Lesser of 60% of the essessed value of the homestead or $45,000
NoMifhsfending eny oNerprovision, fha sum W fhe Eaductiorts povitled in IC 61.7-12 ro e rrnW7e home Me7 is $
not essassetl es �eal property a to e man'daQUred Aome Naf is nof essessed es rael property may not excaed
one-r,au 1rzl olare essassed velue a tne rmbae hwna or men,dam,red rarne.
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INDIANA SALES DISCLOSUREFORM SDFID: 2
� D. PREPARER : - - - •:: - t,.'r - ; �,; �:�
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PreparaoffheSaloD4d reFarm T(tle
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Addrm ombaand5treetJ
Clry,Sfutqand9P da / TdephoneNumber E-mall
;E: SELLER G OR = _ _-* ; ..� - � :�`•� -` < N.:; '. :;
S � a U2 -
Sd/a � amemaypmn am anttdacummt Sd1Q2-Numeaxappranwmnveyonredacvmmt
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Add (NvmGaa�dSbxt) AddJm(NumbaandSbeetJ
�b�i ti� � �� �'3���,
Gry, Smte,
T eNUmb� Emoil T eNumDer E-mail
Under penaldes of 'ury, I 6ereby ceriify that this Sales Disclosure, to the best of my Irnowledge and betief, is true, corred
and compt e equ ed by Iaw, is prepared in accordaace with IC 6-1.1-5.5, °Real Property Sales Disclosure Ad°.
Agnamre la Agnomreof5dlc
e� oU�z ,(��s�. /O--r'/-!L
RintdName Shcc .4 nDate MM D AinfdNamen Shca 9 n0ah N.V D
F: BUYER GRANTEE - APPLICATION FOR PROPERTY TAX ' :?'�