Homestead_Michels n CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
to STANDARD I SUPPLEMENTAL DEDUCTION FORM
s° HC10
State Form 5473(R17/1-16)
Prescribed by the Department of Local Government Finance .
INSTRUCTIONS:See reverse side for filing instructions. ;II,Telephone, Soda!Security, driver's license,state identification and federal identification numbers are confidential un r C 1.998 1
contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, )' (date of�!n• 1yrm1ri' .•
id Own- (\ti Cp11 hQ,4cjf on ❑ Am (are) buying under recorded contract. GIBSON COUNTY AUDITOR
❑ 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.
❑ Am (are) the shareholder, partner, or member of the entity that owns the property.
- - • -
",. -:•
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
•' ' PROPERTY DESCRIPTION- .
County, - _ " - Township " Taxing district(city,lawn,township) -"
C& Ihson v nio � C-oe_i - 02_anc
Parcel number Legal description /[� (�� I Is the operty in question:
2f_ 24_ lU l—W0 �/5—O 15 23 rj(' N0 fre�al property ❑ Annually assessed mobile home(IC 5-1.1-7)
1g l ll l L 1 L.� 1 t ha 1
If any portion of the residential structure or the land not exceeding one(1)acre that imm iately surr u ds hat structure is used to produce income,describe the use and portion
of the property utilized to produce income.
t PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacarng a homestead?
❑ Yes [ 'No
Signature of claimant
Thereby certify the above statements are true, correct, and complete. / ' gn n6_c �f 25•
I Address of contact(number and street,city,slate,and ZlPcode) Add es;�acated omestead,if if any(number and street,city,state,and ZIP code)
' ASSESSOR USE ONLY• ` I'- " ASSESSED VALUE I', " HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land not exceeding one(1)acre immediately (1) IS:`�` �; ' :k1` •'
surrounding residential improvements
Other land (2) -,,x°°s a'1''ul .tk
Total land(line 1 plus line 2) (3) >�. -•p+^ �
Residential Improvements or Dwelling (4) j ;: '
- 1 = "' =`s'
annually assessed mobile I
manufactured home Garage (5) I -v s E - ?'-�
'4""v---
Other improvements (6) i, .h j ,tbn-74-iS7r_, '
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor Date signed(month,day.year)
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
. .._:-STANDARD DEDUCTION ALLOWANCE - • -
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(1/2)of the as essed value of the mobile home or manufactured home.
Signature ' itor ^ Date signed(month,day,yea
Signature '
.,# RL ` 1 - 30 - 1 �l
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
;D:JPREP'RE[t; ,ril _ x.'z. i,3 > d' n''°� az_:,6?`x .fi":R.37t&!�`L iFo ff -er, .uy:.,v.'. `k3. aW1
ANNIMIN17112 MG �. J7PZ
Prepare,-oft j..es Disclosure -. m
Addeo s(Number and Street) Company
�a 1/%/ /,V c477/5 8/2-'IOZ 6555 C/c5ii-95(eirete-6We%.
City.State,and ZIP Code Telephone Number E-mail
ea)
SE SEI:LER S .GRANTOR_ Ski 3 ```ac'�"� 1 fin-7.f. . N- CF. :- r w " `715:4 tl
///// Iecy�I -r .m/a `!_ —
Selle Vame as op rs on corn• once document Seller 2-Nome as •epee o onve}vnce document
/a / 5 V (1-7�//Cc Dr - p/a/ 5'• G7Dr/CZ d�•
A es(N'umbe rd Street) ss(Number ar tror)
ur t fi'orri?, /Al X 7 6 vri
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
ant complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Proper Sales Disclosure Act".
t //L
"an orire of Seller N Sig nature ofSelrr/� ,-
�/ ?// .' • ■ • is Alp// lint) 20.49--
Printed Name of Seller Stan Dote(MM/DD/'nril Printed Name a Seller
( Stan Dote(MN/DD/YYYII
+F.'BUYER S -,GRANTEES;,'APPLICATION'FOR+PROPERTYTAX
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION I. —4 —f/
qtr/❑ 1.Will this property be the buyer's primary 0- ❑ 3. Homestead GIBSON COUNTY AUDITOR
re -•1"— -' 'rovide comp e - :•dress of primary ❑ R- 4. Solar Energy Heating/Cooling System
re '+ence,in luding co
�� v. El [• 5.Wind Power Device
Addres(Num., ands :_) ❑ 9- 6. Hydroelectric Power Device
I S lie• I!- -4 J ❑ Er 7.Geothermal Energy Heating/Cooling Device
City,State ZIP�Code County
\\ LL-' 2.Does the buyer have a home i in Indiana to be ❑ E. 8. Is this property a residential rental property?
vacated fo t- 7..; e. If yes,provide ❑ 9 9.Would you like to receive tax statements for this
complete address of residence being vacated, II 11 t� '�
including county: a�j' t�QQ 1 �D I •y/S ( � on
tr u Not Ova.. ut wt wu nuca./
Address(Number
ZIP rrund Street) Yj 1/7e n 1) * I Ve R �/
City,State ZIP Code County
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