Homestead_Parker t.._t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION HC10
r 1 t State Form 5473(R13/12-09)
'�4=7-^
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
' "�' co-se.�.,-'- CERTIF;ICATI��~ONSTATEMENT'•� -'fir..-'R C - I_jA�IS:da�7ti 3 -r to S6 '� i=
I(We) al u` 1O I'i�.C��y��;�4_ i - �'r#fanile f&+fe kilrt grl
place of residence or am(are)buying the following described real property for d a ''• '--a: •roperty Tax Stay Orfi Deduction is hereby claimed
under tract on the date this application is filed, (date;f Wi 1 �(Vyp,):14-
❑ Am(are)buying under recorded contract 1Y1 U [u A _, Auditor
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation I.•r �InwII1, Gibson County
❑ Have a beneficial interest in the trust or the right to occupy the property under th- i,•(), vs-T:10-d personal residence trust
El Am(are)the shareholder, partner or member of the entity that owns the • 0.% COUNTY A
•c .r. > �.t 't',? 9 . ;.-ter. .... +.�-q.• galiliriSi. 1`.r j`3;ty� r._. y'ite t, • ^ a, - £•l;i..
-7i_.-�"�v+z?"�+r`'v�i`�'�'3i�.i:-�'p.� ���'1'n"i-`.�`r '~CL�A�MANT:S'INF,ORMATION. Ca�eri' ,�kl»`L:�...aFr.......,&�'_.t�.a-;v..t?.:�Jr.
':
If buying on contrail,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
_ ,,t - -fr..- c S={ �c;Ffgel tit :m, '+." -Ss S ' (?ROPERT;Y1DESCRI.TIOFIC > ..m - °}4and E_te' -414- -je 1i ZA-22;;?hai
32. iYct. :Slam,F_.s.�--=,n4iY._<v�ii c L s"", "}j
County Township Taxing district(city,town,township)
P I umber Legal desolation Is the property in question:
b t-{g- 400- OP a . 066- CO 1 a ❑Real properly ❑ Annually assessed mobile tame(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre t immediately surrounds that structure is used to produce income,desarbe the use and portion
of the property utilized to produce income.
P. .; Vii' ttLehra�W"{ lVini-PRO€611.4OW147_1:-mYI AIMA4Tp''IN OTHER COUNTIWILS jv13sh&1 ifs-` :c''_ ri3._..- 3;1-
County Township County Township
I hereby certify the above statements are true,correct and complete. 5X9lna'wre S�of claimant ^
Address(number and street city,state,and ZIP code) 1 S IK/ �-
Zt D 6 o Sr k- C -C.' q-"16 t2
r i -' A ^^' ^' itsit. - A!`=*� `-IZ,ti t r-rT,-.4.� r"`varr-- 4j"�"ts�ASSESSED VALUE'stT?HOMESTEADS '{t'-7s1/27 t „t
!- a SS SORu3E,opthy o.a2,-,-TRUETAX•VALUE •'�fKwno VOFFT.TVi:r t i:. .icVALUE'r£ `X�t?,w-_
- -� �� i " wa,•wYi � VALUE 'a�
Land not exceeding 1(one)acre Immediately (1) ' ;_S; .r : _.'
Ili-
surrounding residential Improvements. ` - -
a•.
Other land (2) . ,_ :; z+.�
Total land(line 1 plus line 2) (3)
Dwelling (4) ; „-k. A w-"tu -s `
ResidentialimprovementsorAnnually ,.
Assessed Mobile I Manufactured Home Garage (5) r't . Y ,-: '- -. .. ..1.
Other Improvements (6) - .
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
•
•y am W.1;`"a X,' y?g 14 f, 4 '_rf 4TANDARDIDEDUCTI3W 1=1OWANCEyS:S� s•'"a es ilk,'&in a'r r2ta i
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 6-1.1-12 to a mxlbge home that is $
not assessed as real properly 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)