Homestead_BennettCLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD if SUPPLEMENTAL DEDUCTION
State Form 5473 (R13 / 12-09)
t Presaieed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
II IN 2 2 mg
I (We)
certify that I (we)'�— ur) principal
place of residence or am (are) buyi the following described real property for which a Homestead Property Tax Standard Deduction " h y claimed
contract on the date this application is filed, (date of filing). I
(We): GIBSON COUNTY AUDITOR
�er
Own ❑ 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
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Name of ni (%gal name)
Social Security rumiber of cial mant (last five off9b)
Driver's license I Identification /
name)
Social Security number of claimant's spouse (last five dgCs) Drivers license / Identification / Other number
Issuing State
of claimants spouse (last rive d4ft)
• nvmm
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
e•
9ffam 800"M
County Township Taxing district (city town, township)
Parcel number Legal description
Is
a
party In question:
r� ^
3 FL • )_0 I • b
l property
❑ Annually assessed moose lame (IC 61.1 -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.
Township
County
Township
County
I hereby certify the above statements are true, correct and complete.
Signs meant
Address (number and street, , at e, and IP )
S
Land not exceedin 1 one acre Immediate
surrounding residential Ion rovements.
Other land
(2)
y?y:l -•jN�3
Total land (line 1 plus lure 2)
(3)
Dwelling
(4)
Residential improvements or Annuafy
Assessed Mobile /Manufactured Home
``{f
Garage
(5)
Other improvements
(6)
"iz ^ , s'i x9
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above Is true, correct,
Slimu a of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Not ithstandiog any otherprovision, the sum of the deductions provided in IC 61.1 -12 to a mobile home that B
$
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one -half (1/11 of the assessed value of the mobile home or manufactured home.
Signature of Au6ta
Date signed (month. day, year)
(0 -a