Homestead_Caldemeyer' CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13112 -09)
uw
Prescribed by the Department of Local Government Finance
KNO-1
INSTRUCTIONS A.
CFRiirl IC TON STATEMENT
,me)
certify that I (we) ocipii�'as myv ,')-pincipal
place of residence or am (are) buying the following 'bed real property for which a Homestead Property Tax Standard Deduction is here"i
der contract on the date this application is filed, (date of filing). I(We):
GIBSON COUNTY AUDIT
Own ❑ Am (are) buying under recorded contract
Arf1 (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 claimant (legal name) Ali
Social Security
Name of da nt's spouse (legal name)
Social Seauity number of datrnanrs spatrse (last rive digds) Driver's ficemsa I Identification 1 Other number
Issuing State
of dainmrs spouse (last five dlgits)
• •-. .
If buying on contras, Fee Simple owner's name
Recorder's office where contract is recorded
Record number Page
Coin
Township Taxing ( , town.
ie)
U l�
Parcel number
Legs espin the party in Question:
//
`L ® property
❑ Annually assessed mobil. tome (IC e- 1.1 -7)
If any 'o f the residential structure or the land not exc6bing one (1) acre that lmn d to produce income, describe the use and portion
of the u zed o produce Income.
® /3- aG -c;,?dU - 1,2ol_ h
MMMM
County
Townldp
County
Township
I hereby certify the above statements are true, correct and complete.
Sig ore ai ant
Address (number and street d01 state, and LP code)
S
• .
• r
•- •
•
Land not exceeding 1 (one) acre Immediatey
_
'w 1ss, -, y- ,.
sumeundln residential Improvements. (1)
[,
Otheriand
(2)
3
Total land (line 1 plus line 2)
(3)
Dweliing
(4)i-
r•`1 }A':..t
Residential Improve or Mnualty
Assessed Mobne I Manufactured Nonce
age
(5)
°
Other improvements
(6)3u.1;?
Total improvements (line 4 through line 6)
(7)
Total value (line 3 Plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day. year)
and complete.
VwfyuV 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
Nofminstarxi g any other prm=on. the sum of the deductions Provided th IC 61.1 -12 to a rnoW7e Mme that is
$
not assessed as real property or to a manufactured Mme /hat is not assessed as real property may not exceed
one4wff (12) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)
u ■ u 11 M