HomeMy WebLinkAboutHomestead_Shafer (3)`°" CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTALDEDUCTION
Stata Fartn 5473 (R13 / 12-09)
� , Pnesrritw� W the Oeoartment of Lorai Gwemment Finarne
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INS CTIONS: See verse side /o� fiGng insfnictions. S e r" � U N
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I(yye) certiry that 1(we) ocwpi� as ) P��Pa�
place af residence or am ( ) buying the following de �bed rea pmperty for whirh a Homestead Property Tax Standard Oeducfion is e daimed
�erconVaIXonihedate is pplirationisfiled, (dateo�filing). I(We): GIBSONCOUNTYAUDITOR
Own ❑ Am (are) buying under recorded contraM
] Am (are) entitled to occupy as a tenent-stockholder of a cooperative housing corporation
❑ Have a 6enefidal interest in Me Wst or ihe right to oaripy the property under ihe tertns of e qualified personal residence trust .
❑ Am (are) the shareholder, partner or member of the entiry that owns the property.
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Nama of ' )
Sodel Seaaiy
Soclal Securiry numher ot tla6nanYs spouse (last flre Oigds) Orivers lioeroe / Itlentlficallrn / Other mimber IssWrg State
o+da�manrs spouae (WSr mre o'yits)
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If buying on contra�t. Fea Simple owners �wne
Recordefs office where contract is recorded Remrd rwm6er Page
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Counry Township Ta�ung ..(�, I . townshiG)
Pa`ceJ number Legal tlesmPtion Is tl�e ProPaM in Question:
❑�i c�a�r ❑ a�nuaoy assessea mome ro�,e �rc c-i. �-n
If arry portion of ihe residen11a1 sWCNre or the IaM nol excaedin8 rne (1 � aae that ImmeCately surtounds ihat sW�re is used to produce income, dcsaibe the usa aM pation
W tl�e P�hY u6i'¢ed m ProAUCe Nwme
�G- /� -a � a/-QD�. 090 -o�
... . . : . .
Counry To�xnship Counh T�P
I hereby certify the above statements are We, correG and mmplete. y� tb� `���
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number q rity, state. ard ZlP oode)
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Land not axceedmg t(orre) acre ImmedWmty ��� �;,,,�.y-'`""--r.n ��-�.,.� �fi �;_
surtounEln residentiallm rovemerrts. -
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Other lantl (2) „� �;•�_„R ;i_
Total land (line f plw Ilire � (3)
?� z` �.t �'r. Ca.�l^�.� :r �£�
ResidentiallmprovementsorAnnuafly ����ng (4) �."�N�r� �z�. ,.£ � m�
Assessed Mo6tle I Manufachued Home Garege (5) `5 •��`�,��'� a�.>r. ���i.%���?�`-a
ONerimprovertrenffi (6) '�r'}'' �Si'�a�: ��
Total improveme� (Ilne / Nrough line � (7)
Total value (/ine J pl�a Ilne 7) (8)
I hereby certify the abova is Vve, cortect, �9^a��e of wssessor D�te si8� (^p^N. �Y Y��)
antl eomplete.
Verifyug aCim - Sigreture o(fuMitw Data signed (monN, tlaY• l��)
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20 _ pay 20 _ Lesser of 60% of the assessed velue of the homestead w$45,000
Nohvitluteriding any oMer provisbn, the sum o/the deducf;ons p�ovided in IC 6-1.1-12 ro a mob�7e homa fhat is $
not assassed as real property w ro e menNaUUred Iwrt�e fhat is rat essassed as real property may rwt exceed
oneJiel! (f21 af the essassed vehre o/fhe rnoWe frome or man�red hmre.
s�nswre ot aneaor Date signed (month, day, yea�
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