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1 CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
•�_� State Form 5473 (R21 17.25)
Prescribed by the Department of Local Government Finance
FORM �R
INSTRUCTIONS: See reverse side for riling instructions.
NOTE: Telephone, Social Security, driver's license, state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
I (We) t�
certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the foll�orw=n� described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, l _ �l
_ 9 � 0. (date ofsignature). I (We):
con. ❑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 personal residence trust.
DAM (are) the shareholder, partner, or member of the entity that
owns the property.
INFORMATION
Name of Claimant (/egalname)
T(e�leSSp.hryon`e Number of Claimant Emall Address
Social Security Number of Claimant (last five digits)
�1
Drivers License i Identification i Other of laimant (last rve digffs) ,
(Applicable only if applicant does not have a social security number) Issuing State
Name of Claimant's Spouse (legal name)
Social Security Number of Claimant's Spouse (last five digits) Driver's License Identification I Other Number o Claimant's Spouse (last five digits) Issuing Stale
(Applicable only d applicant's spouse does not have
a social security number)
CONTRACTRECORDED
If Buying on Contract, Fee Simple Owners Name
Recorder's Office Where Contract is Recorded
Record Number Page
PROPERTYDESCRIPTION
Co ty
Township
Taxing District (city, town, township)
N
{�
'
Parcel tuber Legal Description Is the prrry in question:
real Property ❑ Annually Assessed Mobile Home (IC 6-1.1-7)
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.
State County
Township Is Claimant Vacating a Homestead?
❑Yes �Ntr— °
I hereby certify the above statements are true, correct, and complete. Signa r f daimant
Address of Contact (number and street, city, state, and ZIP coda 1 Address of Vacated Homestead. if any umber and street, city, state, and ZIP code)
I OS �
• 1 � LA R .
Land Not Exceeding One (1) Acre Immediately
Surtoundin ResidentialImprovement (1)
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Dwelling
(4)
Annually Assessed Mobile
Manufactured Home
Garage
(5)
Other Improvements
(8)
r
Total Improvements (Line 4 through Line 6)
(7)
Total Value (Line 3 plus Line 7)
(8)
1 hereby certify the above is true, correct, and complete,
signature of Assessor
g , e th, yepR
GOU
Verifying Action— Signature of Auditor
Date Signed (date, month, year)
Bam • • • • •
For assessment dates after December 31, 2024: in 2025.
20 pay 20 $48,000; in 2026, $40,000; in 2027, $30,000: in 2028, $20,000;
In 2029, $10.000; and beginning with the 2030 assessment date
and for each assessment date thereafter, $0.
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 (112) of the assessed value of the mobile
home or manufactured home.
Signature of Auditor
Date Signed (month, day, year)
_11— tvc_— _CA`
uiartxttturlON:Original —County Auditor, File -Stamped Copy —Taxpayer f1_,
Page 1 of 3
a
•
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Karen S.Creek Bosse Title Company
Preparer of the Sales Disclosure Form Tide
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000 closina.dept @ieffbosse.cdm
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) . . • , _ ;
•
Estate of R Frank Williams
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
loc $7 n1erina,.c. Dr
Address(Number and Street) Address(Number and Street)
MCC to ii...-3 6, Z N q7630
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".
� cads
`r • ow
Signat�Y Selle
Signature of Seller
Marjan W.I aGrange.Personal Ren. 9 • .1 SV20/6 - ', �1
Printed Name of Seller Sign Date(MM/DD/Yrri) Printed Name of Seller ` NV 'et -I/DD/YriY)
F.BUYER S /GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITE THAT APPLY
Joshu. Lamb Rebecca Lamb JUN 9, 9 2n)s
- Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
105 N.Main Street 1e N.M.in S r-e
Address(Number and Street) Address(Number and Street) ,I i, �/ll;i
Fort Branch,IN 47648 Fort Branch,IN 47648 GIRSON COUNTY AUDITOR
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ar9er—emeiTh3.
0 ❑ 1.Will this property be the buyer's primary Ho
residence? Provide complete address of primary ❑ 4.Solar Energy Heating/Cooling System
residence,including county: ❑
5.Wind Power Device
Address(Number and Street) ❑ 6.Hydroelectric Power Device
City,State ZIP Code County ❑ 7.Geothermal Energy Heating/Cooling Device
❑ 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 ❑ 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
•.t rt • I c e•
Address(Number and Street)
d‘ - 18 -13- 904 - Coo. 8iy _ 0 ,i _
City,State TIP Code County
eecitizsayoumer contact name -mail