Homestead_Dawson� R.n 1\^ „`1 P��
CLAIM FOR HOMESTEAD PROPERTY TAX 4=�'�' i �
� STANDARD/SUPPLEMENTALDEDUCTION �,�
S� ~ Stete Fofm 5473 (R72 / 6O9) c �
�� ��z Presui6ed by che �epartmenl of Laml Govemment Friarce � `. �
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INS7R1/(:TInNS-.Cww rwvnrtw <irlw Inrfi/inn inxtrtrtinnx.
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FORM
HC10
YEAR
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I(We) rtify that I(we) ocwpied as my (our) prindpal
place of residence or am (are) buying the following described real property tor which a H estead Property Tax Standard Deduction is hereby daimed
under conVact on �he dale lhis applicalion is filed, (dafe (ling):
❑ I(We) own ❑ Am (are) buying under remrded contrac[
❑ Am (are) enfitled to occupy as a[enant-stockholder of a cooperative housing corporation
� Have a beneficial interest in the Wst or the right to occupy the property under ihe terms o( a qualified personal residence Wst
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� Name of da"unant (kgal reme) , `
1�•
Sodal Seartiry nunb� of daonanl (last fr,e d'93s) D�ivefs license I Itlen tion I Other number ing State
ot tlaimam (Wst Irve d J
Narne o( daimanYs spousa (lepal neme) ,
Sodal Seamry number ol tlalmam's spouse (last five d'grts) Drivefs ticense / Identification / Ottier numCer Issuing State
of daimant's spause (last five dgifs)
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11 Grymg on cnntracl, Fee Simple ownefs �ame
Remrtlefs ofire where tontracl is recwEeO Rervrtl numbrs Page
._�. . �
�nry Township T' dis ' '. b ;town iP)
Pa(cel number le9al �escriPtim Is Ihe p�operty in puestion: �
� wcvem ❑ nM�a�y �aie n� �ic s,.,-n
tt arry portion d the residential sw�wre or Ne land `rot exreedirg ana (1 � ace ihat immeEiateJy Ms �hal strucWre is used m pmduca iMOrne, Oescnbe Ne use aM ponion
of Ne property utifaed to pmduce inmme.
a Co-� a-ZO- 2-bo-c�o. ��5 - o�.
... . . : . .
Counry 7rnmship Caunry Township
1 hereby ceNfy the above statements are we, cortect and complete. Siy�mre o( daimam �
AOAress (rvimDer and street, ary, slate. and LP code)
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Land not exceeding 1(one) acre immediatety � �"l�` k,'nr�� �! $''� i'�'��7r;
surtoundin residen6al im rovements. � � �=`-�'-�+ � h`'� -•"�=i%'•�
.�-Y =s.-" b`�.F
Otherland (Z) r�.,F _r��
Toul land (line 1 plus line � (3)
/ ;�
�V/l��1l19 \4� y �i:��w E9�E$ `h'�'P;ts�:� �4Y-"Y.'
Residential ImOrovemen5 or Annualty
Auessed Mobile I Manufac[ured Home Garsge �5� ='.s'� w�� ��i'"9�" 1 �x:'�t�
Q.<� �v'y�rcF`�,r��`..xs4.i-c�s9:
� .�r,r,..i --� :yas.:i,.
Other improvements (C) _i;x;N�i'�:t:-�.'.�',�,°s.z'-';
Total Improvemen5 (llne d NrougA Ilne 6j (7)
7ota� value (line 3 phs fine n (B)
I hereby certify the above is true, cortect, Sigriature atnssessor Daee slgned (month, tlay, yea�
and complete.
Vuining acoon - Signature Wluiditor
Date s8^� (mon1M1. tlaY. Yea�)
� . . � � � • �
20 _ pay 20 Lesser of 60% of the assessed value of 1he homestead or 545,000
NotwiNStanding any ofAerprovision, Ne wm d fhe deductions provided in IC 67.7-12 ro a mo6�le fartre (�ef is g
rot assesseC es real poperty a Io e menufeUUred home Nat is rrot essessed as real pmperry may rot exceed
mtrhaH(f2) o1Ne assessad velue ol Ne mobde home ar manuFaUUred hwrre.
SgnaWre atNditw �ate signed (rtpnfh, day, year)
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
nruuux am.w zin
C.[WERVMII.i iPA fE �C4�I.I�L'� 1
IndividuaL and mvriN <ouple arc limi¢d �o ore homeueaJ itafMaN Jc�lu.iion. As �hc rttcip� oi �his dcdunion bttomes
merc beneficial. there is morc irnmtne dun e�rr for M1omesteal BaW. Ilomn:ead fmud caaces hi�M �a� bilis iw all: thercforr.
HEA 13�1i-3IX79 requ"vrs �iapacen who recei.e �he hanes�:aJ standa�J deduction in .�erilv ilu� �hey are elieiMe io mcene ihc
benefit anf to pnn'ide xWition�l iJemitrin� inform�tiun �cresan� �o allw� counn gmrmment ro bBrcr muniror Iwmse:rl
fili�,�. Ifiis inlnrmaiion x�ill M Aryw conlidemial and on only M. an�uA F�� autlror'vn1 cnunry� n0iri�la'Ihr Ikpanmeni of
lucal Gmertvnrn� Fi�uirce xill u.e thfs fnio�manon w crw:c nnls du� a�ill hdn cnunrr aR "aL. diminnm h�xnenead &aud.
4044
Shelia Elaine Dawson
do Shelia Miller
1035 E 150 S
Princeton IN 47670-8715
I�I��II���I�II��I���III���I��I�I���I���II�I�I���II��I�I�I���II
Tnipaver Name
Dawson, Shelia Elaine
Prooem� AJdres+
/0 3S� /So S.
PrincetonlNJ7670 �`�
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State Parcel Number Leeal Description
2Cr12-20-200-000.435-027 006-ooa35-oo PT W NE 20 210 2.116 AC
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Owner I First MidNe LaU
�HE r � a � c� i,u� �11 � LLc,'n—
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g Addr�+ (numbcr and itrcet, city. smtc, end ZIP codc) "' '---' --- --' ' � 5nme m- propem'oddi¢c "-- -'
3S � • �Sl� S. . --- ---
�QaN-GCTo� ��. `�7�7
Social
Middle Last
�p��p (.� }'�l l LL�.�L—
Mailine Addrtss (Number and slrce4 �ty, sWle, and LII' cutk) S;une a� pmpeny adJtas
0� C /u� sI•
YK/KC�c6ZD.tJ L/�J . �%�D G
Social Stturirv Numbcr (Lsst 5 digi�
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Fach undersigned cenifies, under penalty of perjury�, that the abo��e xnd foregoing information is we and corrzc� and thvt he or she is eligible to
receive the homestead standard deduction on this property. Each undersi¢ned al,o unders�ands that, by claiming additional homestead deduciions
unlau�fully, he or she may be liable for back taxes and substantial financial penalties.
O..�ner I $i�mawrc . Datc Telephonc
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