HomeMy WebLinkAboutHomestead_Harvey (4) -c•• CLAIM FOR HOMESTEAD PROPERTY TAX
A1 YEAR
l•o STANDARD I SUPPLEMENTAL DEDUCTION FORM
, State Form 5473(R21 i 7-25) HC10 2)----
'••• Prescribed by the Department of Local Govetnrient Finance
INSTRUCTIONS. See reverse side for filing instructions.
NOTE. Telephone, Social Security, driver's license, state identification and federal identification numbers are confidential under iC 6-1.1-12-37
CERTIFICATION STATEMENT
I (We) P V`� lik 1111 1 e. w.., - certify that I(we)occupied as my(our)principal place of
residence or am(a :)buying the follgwli,gA I under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
•ate this application is signed, C 1..._( lJ (date of signature) I (We):
�e Own ❑Am re)buying under recorded contract
• - (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
ElAm(are)the shareholder partner, or member of the entity that owns the property
CLAIMANT'S INFORMATION
Name laimant(legal name) Telephone Number of Claimant Email Address
,/ - 001 ) gIg -71S' 1 .
Social nty Number of Claimant(last five digits) Driver`s License/Identification/Other Number of Claimant(last five digits) Issuing State
(Applicable only if applicant does not have a social security number)
bet cg3 .
Name of G • s Spouse(legal name)
`i. `) rof Cl Drivers License 1 Identification i Other Number of Claimant's Sp
ouse Security Number Gaimanrs Spouse(last five darts) (last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT RECORDED
if Burying on Contract,Fee Simpte Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township ......_\____ Taxing District(pry.town. township)
9 , _) 01\''
Parcel Number Legal Description Is the .roperty in question
I- 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 sun. •is I structure is used to produce income.descnbe the use and portion
of the property utilized to produce income
ap ....— 1 v ,zirs---_____ ,--2„..... 3
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County Township Is Claimant Vacating a •7 (14j("'CA
❑Yes 1111 No
i
attire of Claimant
I hereby certify the above statements are true, correct, and complete. 7.--- ._,-----
A.• ass • Contact(number and street state, rid ZIP code) Address of Vacated Homestead,if any(number end street,City. e. and ZiP code)
q • — 1 rDf\
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAn V."-.Lut NON RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land (Line 1 plus Line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile i - ,
Manufactured Home Garage (5)
Other Improvements (6) b 256
Total Improvements(Line 4 through Line 6) (7)
Total Value (Line 3 plus Line 7) (8)
Signature of Assessor sFT/JED
llf S ran nyear)
I hereby certify the above is true, correct, and complete. �'BSON C011� ' ,� t vrT
Verifying Acr�on-Signature of Auditor Date Signed (date,month,year)
STANDARD DEDUCTION ALLOWANCE
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(1/2)of the assessed value of the mobile r
home or manufactured borne
Signature of Auditor Date Signed day,year a
ill z •` ` \\ 1
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer --_________,
Page 1 of 3
oY—qq
/5 . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
44STANDARD/SUPPLEMENTAL DEDUCTION
itioState Form 5473(R 19/1-23) L HC10 aod3
Prescribed by the Department a'Local Government F,nance
INSTRUCTIONS See reverse side for filing instructions.
NOTE.Telephone,Social Security,driver's license.state identification and federal identification numbers are confidential under IC 6-1,1-12-37.
CERTIFICATION STATEMENT
I(We) NI VI S aNe"\ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date�,/this application is signed, to/I o1/Q 3 (date of signature) I(We) /
L�Own ElAm(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
❑Am(are)the shareholder,partner,or member of the entity that owns the property
CLAIMANT'S INFORMATION
(..-....4-..."--)
Name of Claimant(legal name) Telephone Number of Claimant Email Address
rbesJ�w S K�hey clot Nu
) 0 is^l ls( CT
Social Security Number of Claimant(last five digits) Drivers License/Identification/Other Number of Claimant(last Ave digits) i Issuing State "k'N 'AN\\,)f` -i;
C1 6y- (Applicable only if applicant does not have a social security number)
of Claimant's Spouse(legal name) 1 (�1,,Z _II)
Social Secunty Number of Claimant's Spouse(last five dig(s) t Drivels License/Identification/Other Number of Claimant's Spouse(last five digits) Issuing StateCZ....q s....4.4
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT RECORDED 0
I Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
4
PROPERTY DESCRIPTION
County Township N1 Taxing Distnct(city.town,township)
tb5o✓� /ram er`� 1
Parcel Number1 Legal Descnptw`n .t �—� Is the pro rty in question \�
9(0• \O-a5—a0Q—-7os—?�L T(�.a\ eat Property ❑Annually Assessed Mobde Hone(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(II acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income k
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is C m nt Varatinn= tead9 1
Ves
-
•WIV ..".2 ( _)
1 Sig .t.of C;ai i- O
I hereby certify the above statements are true,correct,and complete
i
Address of Contact(number and street,city slate and ZIP code) Address of Vac e.Home tead,if any(number and street City,srate�rl�i4Pao�el
( Ctq S '1S • �NQ�Sv\\.\Q rJ 976 ' 5
ASSESSOR USE ONLY ASSESSED VALUE 1 HOMESTEAu VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1 j I 0
Surrounding Residential Improvement f
Other Land (2)Total Land(line 1 plus line 2) (3) ] 'i[Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) — - OCT l ���
Other Improvements (6) Lil
11
Total Improvements(Line 4 through Line 6) (7> , /�j L
Total Value(Line 3 plus Line 7) (8) ,�� a.liAYI�L�I�.�e.,:,koo 1
Signature of Assessor GIBBON COUNTDYte'9rtdrev(o l lwionth,year)
I hereby certify the above is true,correct,and complete. A,
Ventying Action-Signature of Auditor .Date Signed(date month,year) l�I
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000
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 assessed value of the mobilehome or manufactured home
Signature of Auditor/r, ■_ 1 ` iti��` ,►y Date Signed(month.day.year) _ _. ___ _
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2
e
STATE OF INDIANA ) IN THE GIBSON SUPERIOR COURT
COUNTY OF GIBSON ) CASE NO: 26D01-a31#DN- Di Cap
IN RE: THE MARRIAGE OF
DECREE OF DISSOLUTION OF MARRIAGE AND SETTLEMENT AGREEMENT
❑ The Court having reviewed the Verified Petition for Dissolution of Marriage and having held a final
hearing in this matter, now finds the following:
❑X The parties having submitted their Settlement Agreement and the Court having seen and considered the
Verified Petition for Dissolution of Marriage and Verified Waiver of Final Hearing submitted by the
parties, now approves the following agreement:
i.
1. The parties were married on 01/‘. nd separated on Ctl' 11 202:3
has been a continuous resident of Gibson County for the last three months, and the State of
Indiana for the last six months prior to the filing of the Verified Petition for Dissolution of Marriage.
3. N (select) pregnant.
4. Neither party is a member of the military.
5. Children:
tat There are no children of the marriage.
❑ There were children born of this marriage; namely:
Name Date of Birth
6. Custody and care of the minor child(ren). It is in the best interest of the child(ren) that:
❑ The parties shall have joint legal custody over the minor child(ren) with Petitioner being the
primary custodial parent.
❑ The parties shall have joint legal custody over the minor children) with Respondent being the
primary custodial parent.
e
❑ Petitioner shall have sole legal custody of the minor child(ren) and shall be the primary custodial
parent.
❑ Respondent shall have sole legal custody of the minor child(ren) and shall he the primary
custodial parent.
❑ Other: (please describe in detail)
7. Parenting Time with the minor child(ren) shall be as follows:
0 Petitioner shall have reasonable parenting time with the minor child(ren). at a minimum.
0 Respondent as set out by the Indiana Parenting Time Guidelines.
0 Other: The parties agree that it is in the best interests of the minor child(ren)to
follow a parenting time schedule that does NOT follow the Indiana Parenting
Time Guidelines (please describe the schedule in detail and give reasons why
the alternative schedule is justified):
8. Child Support
will pay child support in the amount of per week, as shown by the
❑ Petitioner attached child support worksheet, through the County Clerk's office, or by
❑ Respondent income withholding order if available from the employer, beginning on the
first Friday following the date of the decree.
I Petitioner
shall be responsible for payment of all controlled expenses related to the
Respondent upbringing of the minor child(ren). (For use only in cases when parenting time
is equally shared.)
will be responsible for the first of uninsured medical expenses for
❑ Petitioner the minor child(ren). Thereafter, Petitioner shall be responsible for%of
(1 Respondent uninsured medical expenses, and Respondent shall be responsible for
of uninsured medical expenses for the minor child(ren).
❑ Petitioner will be responsible to pay the administrative fee that the Clerk charges
0 Respondent annually.
9. The provisions for health insurance maintenance shall be as follows:
❑ Petitioner shall maintain medical, dental, and optical insurance as available through
❑ Respondent employment for the minor children:
r
❑ Health insurance for the child(ren) is not available to either parent at a reasonable cost, therefore,
neither party is ordered to provide health insurance at this time. In the event that health insurance
for the children becomes available at a reasonable cost to one or both of the parties,the party to
whom such coverage is available shall obtain coverage for the children within a reasonable time
after such coverage becomes available.
10. The arrangement for claiming the tax credits, exemptions, and deductions for the minor child(ren) shall
be as follows:
Petitioner shall be entitled to claim the minor child(ren) for federal, state, and local
❑ Respondent income tax purposes on an annual basis; The parties shall cooperate to sign all
necessary documents that will allow the party claiming the exemption to do so.
❑ Petitioner and Respondent shall each be entitled to claim the minor child(ren) for federal, state,
and local income tax purposes in alternating years; Petitioner shall be entitled to claim the minor
child(ren) in the year . and every even/odd year thereafter; Respondent shall be entitled to
claim the minor child(ren) in the year, and every even/odd year thereafter. The parties shall
cooperate to sign all necessary documents that will allow the party claiming the exemption to do
so.
D Because the non-custodial shall be entitled to claim one or all of the minor children as
dependents for the purposes of federal and state taxes in some or all of the tax years, for each
year in which the non-custodial parent shall be entitled to claim one or all of the minor
children as a dependent(s),the custodial parent shall take all actions necessary to release
the custodial parent's claim to the exemption in the manner required under Section 152(e)
of the Internal Revenue Code.
❑ Because the parent who is ordered to pay child support shall be entitled to claim one or all of the
minor children as dependents for the purposes of federal and state taxes in some or all of the tax
years, the parent who is ordered to pay child support may only claim the child as a
dependent for federal and state tax purposes if the parent has paid at least ninety-five
percent(95%) of the parent's child support for the calendar year for which the parent is
ordered to claim the child as a dependent by January 31 of the following year.
11. The division of jointly held debts shall be as follows:
El The parties have no outstanding debt for which they are jointly responsible.
❑ Petitioner will be solely responsible for the following debts and shall hold Respondent harmless
from liability, expense, attorney's fees, and loss which may be incurred by Respondent, arising
out of Petitioner's failure to pay such debts. :
Name of Creditor Amount of Debt
_$
•
Respondent will be solely responsible for the following debts and shall hold Petitioner harmless
from liability, expense, attorney's fees, and loss which may be incurred by Petitioner, arising out
of Respondent's failure to pay such debts. :
iy6 Name of Creditor Amount of Debt
$
12. The individual debt division shall be as follows:
Debts held in Petitioner's name only:
Petitioner will be solely responsible for the all debts held in his/her individual name, and all
debts incurred by him/her in his/her name since the date of final separation. Petitioner agrees to
hold Respondent harmless from liability, expense, attorney's fees, and loss which may be
incurred by Respondent, arising out of Petitioner's failure to pay such debts.
Other:
Debts held in Respondent's name only:
a Respondent will be solely responsible for the all debts held in his/her individual name, and all
debts incurred by him/her in his/her name since the date of final separation. Respondent agrees to
hold Petitioner harmless from liability, expense, attorney's fees, and loss which may be incurred
by Petitioner, arising out of Respondent's failure to pay such debts.
( J Other:
1 [he vehicle division shall be as follows:
I I There are no vehicles to divide.
Petitioner will have sole possession of the following vehicles, and Respondent shall execute all
documents necessary to transfer title of said vehicles within a reasonable time following the date
of this Order:
18. Findings of the Court:
® The parties have disclosed all relevant documents and exchanged all information on value of
property, pensions. real estate, and other assets and debts. This document represents an
agreement submitted by the parties for approval by the Court. The parties have submitted a
waiver of final hearing and have agreed that the property distribution provisions of this
agreement represent a just and reasonable division of the marital estate and debts.
❑ The Court, having held a hearing during which both parties appeared and presented evidence,
now finds that the property distribution provisions of this order:
❑ constitute a presumptive equal division of marital property and is therefore just and reasonable.
❑ do not constitute the presumptive equal division of marital property, however are, for the reasons
set forth below,just and reasonable:
IT IS THEREFORE ORDERED by the Court that the parties' marriage is hereby dissolved.
1)ak,. July 13, 2023 41 :fAry die -7�%�%o_
Roman Ricker, Magistrate cs
Gibson Superior Court
Distribution: Petitioner Name& Address
Respondent Name& Address
N1 c affirm under the penalties of perj that the foregoing representations are true.
Petitioner's ig ature
STATE OF INDIANA )
SS:
COUNTY OF GIBSON )
Before me. , a notary public in and for Gibson County, State of Indiana,personally appeared
and he being first duly sworn upon his'her oath, says that the facts alleged in the foregoing instrument
are true.
Date 7-
NOTARY PUBLIC
MY COMMISSION EXPIRES:
Respondent's Signa e
STATE OF INDIANA
)SS:
COUNTY OF GIBSON
Before me, .a notary public in and for Gibson County,State of Indiana,personally appeared
,and he being first duly sworn upon his/her oath,says that the facts alleged in the foregoing instrument
are true.
Date '- I'23
NOTARY PUBLIC
MY COMMISSION EXPIRES: