Homestead_Hopper (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
e STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14) HC10
Presented by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identifcaton and federal identification numbers are confident,:'r .-r; 6-11-12-3 i-•
_ . - - . -- -CERTIFICATION STATEMENT i _ - -I ' f • .-(We) / . art// certify that )— i� :-- "
�, t.G-� � fy (•= occupy• as my(our)principal
place•f residence or am(are)buying the followin,,,6escri•-• real.1.-rty under contract for which a Homestead Property Tax�Sndard
Deduction is hereby claimed on the date this apt cation is signed, (date o#RStfp). I CYS i
❑ Own. ❑ Am(are)buying under recorded contract.
❑ 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 rust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDIT 1
- - _ .
,
If buying on contract,Fee Simple owner's name
Recorder's oftce where contact is recorded Record number Page
c- <_`vt-TP .T rs. `'nett'-. gPROPERTYDESCRIPTIONytn_ c r_.; T. .n-S3.;.•':-4411
County Township 1 Taxing dismd(on',tam,township)
��.
Parcel number L g,desaviior Is the eery N pueXim:33 b G 4y C'?!/) /O ❑Real propery ' ❑Annually assessed mobde borne(IC 61.1-7)
If any portion of the residential saucture a the not ex :rig one(1)acre that immediately surrounds that strucure is used to produce income,describe the use and portion
of the property Laded to produce income.
D2 Co—b,), — 5 , - o 33 - COO . a01 G - a19
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Sax,corny,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
S' ^ te of Winara /-l�y ���TTI
I hereby certify the above statements are true,correct,and complete. - //
Address of contact(number and e+eet eny.s• •,and ZIP code) f Tess of vacated homestead,d any(number and &ate,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land 1(2)
Total land(line I plus line 2) I(3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
1 hereby certify the above Is true,correct. Signature of Assessor Date signed(month.day yeas)
and complete.
Veiyig -on-Signature of kplaor �J ' Date signed(nh,day,year)
› /
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
NOhsithsanding any other provision,the sum of the deductions provided in IC 61.1-12 toe mobile home $
that is not assessed as real 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 motile home or manufactured home.
Sgnn ofP tl.tor
Date signed(mat/.deg year)
DISTRIBUTION:Ong ial-CahNy Audda,FIe-&ed Copy-Taxpayer
INDIANA$ALES DISCLOSURE FORM SOF ID: •. •e 2
D.PREPARER- .. ' . . . -. ,':` '. ,. . - .- . . .` _ a
.ap �_
T.s, Ps At N4
Preparer of the Sales Dbdosu Form " Tlde
.2/I 14
r�/�d ,44 yT4A SA/'.
;fro
4 /C'// o s i, °' Y 7 670 Company
�/2 - G 77-//Y6
iv,State,and DP Code Telephone Number E-mail
^E SELLERS)/GRANTOR(S) '�" . =`" - - rl
Tea/+y CV t. /?"-y q co"
Seller l-Name as appears on conveyance meet Seiler 2-Name as appears on conv eyancedocument
!f e 2-, b.- e2 -°-"oll.
Add (Number nd Street) Address(Number and Street)
Alc?'.�el..,> J e/ f 76 y e
Telephone Number E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required ed law, is prepared in accordance with IC 6-1.1-5.5,°Real Property Sales Disclosure Act".
v mre� o e /Ja tl',�J e! r / / SignatureofShcer
� \/C //i/V CP at0�3
Printed Name o(Shcer Sign Date(MM/DD/YI'YY) Printed Name ofSeller Sign Date(MM/DD/YITY( •
.F:BUYER(S)/GRANTEES)=APPLICATION FOR PROPERTY_TAX DEDUCTIONS4IDENTIFY'ALL ITEMS THAT APPLY`,i� .0 4i`k
T anea'j A(. N �t�e- _ e3,_ T, oft /P�
Buyer l-Name as appears on tan meet Buyer 2- ameasappea •/San veyancedocum-
2 / u4iCc,4 S/- 2f6 wc?se 4e lyib> .SA
Ad)dfrns(Nu an Street) A/dd/(m(Nampo-and Street) / [y {�
]i90 tom hf , -.�s 97ln XD No,- CTGS•, J40 • j 1G/ 0
THE SAIFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES� NO OONDmON YES NO CONDTfON
lJ ❑ L Will this property be the buyer's primary E❑ 3.Homestead
residence? Provide complete address of primary 4.Solar Energy Heating li 3y�te
/J
residences i ludg coup ❑ g 9 Ig 7
7d C/ �. S ❑ [Pr 5.Wind Power Device 111 J n
AddrHlimmberang ❑ 9 6.Hydroelectric Power Device
Q /P � 't T} p/ y 2 ro ❑ m .Geothermal Energy eanU
loI 43e
City, retain
Cade f County
�❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 2'9.Would you like to receive 4: trs _„, .. a is
complete address of residence being vacated; - property via e-mai6 : .�45 ?rc ag a chit
lm dingpounty: j / r w Please see instruce ons or o e • h}f
2 �t Qf 2 e fr9 Sen. 5- ��GN It available in all counties.)
Add (linatbfr and{s$�tr�t) T'� 7 ,6 r'�
z >v AT, 7 T e; �- �1 yta �6 ba 5q-033�o.R. . 0�9
City,State ZIP Code r County
Primary property owner contact no E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act'.(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bein epic? -1n
azure°/Bayer! •
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