Homestead_Conway CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y:11.1:11. > STANDARD/SUPPLEMENTAL DEDUCTION FORM
z@! State Form 5473(R13/12-09) HC10
a Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
WikVi ii%Y �5M9 z itaRFGAISMENT� .X � � � �" Ja�: �� 4��
I(We) `L iV ' • naiMArr ,
that I(we)c�y i( ie77dd ,o,11ur)principal
place of residence or am(are)b A. the f. 'wing described real property for which a Homestead Property Tax Standard'B'cductirA 14 Aby claimed
under contract on the date this application is filed, (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract UL _
Am (are)entitled to occupy as atenant-stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR
Have a beneficial interest in the Rust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
a ,.a' `i " r CLAIMANT'SINFORM ONrelbtfr ns lit tti4 srtt t., i
mss`�,.___, ;�: ������� a, �"""� ,
� d.:i�.t' 7:714.ri ia:S"`.t�,:f;,5n-SK M
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
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�.5.�,.�.-'Fa .�.r}u�: a�vw"".,,�'3 � g�P,RO P,ERT;YiDESCRIPTION�.1�v—,'-�!_"3�'S,-�,.,�T'-l�L��>'1��vY-e,. SL�s �`� ��
County Township TA' • (city,town,township)
Ifni. .
Parcel number Legal desolation ' Is property in question:
o • ^ e s- I. a b ■ • r ' s._ Ea R-.I ❑ Ann :ay. •.. - ••i• r.II; ( • 1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
Ejya., c.xcax.-s:-- 3 - strlie d'.a'_ --.r ,A..._-�_� .-t sc'•` +Ear. r = c.4-(4aPl
...a.s '1.�'n�.iaS- $41%& ,._�,X�_.i.,r�-,a.-: ,.e;^ss`,,,i
County Township County n Township
I hereby certify the above statements are true,correct and complete.
Signature�pNma t% (61\c&- 11(
Address(number and,• -t, • .state,and ZIP code) • I I )y\/—^1I/e/Q ,
. _ 0 It°H. W n to
`�1p' .r�?+�-t'+�? '.T' rx.T`aa�yhr � �''° "l' `° /ASSESSED VALUE. +'HOMESJEAD i ANON RESIDENTIA ' vi
p t...,( ASSESSOR UjSEaON�.n � RUE�TAX` igitAT:100%1064T.TV, aWALUEilt lr.i T> --sti.VALUE ct-Taii t.
Land not exceeding 1(one)acre Immediately ,'
surrounding residential Improvements. (1) '-* -.7' .
Other land (2) ,..- .
Total land(line I plus line 2) (3)
Residential Improvements or Annually Dwelling (4) -e x'r Yx cia yv,-G'-.
p
Assessed Mobile I Manufactured Home Garage (5)
n_3f
Other improvements (6) . .:-.:-C I ---,_ .
Total improvements(lined through line 6) CO
Total value (line 3 plus line 7) (8)
I hereby certify the above is W e,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month.day,War)
i•�� :.1r'"m r .nai,-.ear` ?5..4011 1..IA 5115.EDUCTION�ALLOWAN 4311$1 n«n`T": ^ x$`s'F t3'.ss�` .0:44 26PlktttiM
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 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 mobile home or manufactured home.
Sign itdo _a C2 J CS _ _ Date sired(;t day�)fear)(s- e l
_ _