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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD /SUPPLEMENTAL DEDUCTION
S _ State Form 5473 (1312 / 6.09) HC7 0
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fding instructions.
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following describ al property for which a Homestead Property Tax Standard�y}LJjprJt ty claimed
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under contract on the date this application is filed, (date of filing):
❑ 1(We) own [] Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
❑ 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
INFORMATION
Name of tl 'una (legal am)
_
Soria) Security number of claimant's spouse (last five dges) Driver's license I Identification I Other number Issuing State
of claimant's spouse (last two digits)
CONTRACT ••r r
It buying on contract, Fee Simple owners name '
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township Taxing district (city, town, township)
Parcel numbpr
Legal description
Is the property in question:
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0
❑ Real property ❑ Annualy assessed rtm6ge home (IC 61, f -7)
any portion of the residential stnkwre or the land not exceeding one (1) acre that immediately surrounds that shucture is used to produce income, describe the use and portion
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of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete.
Signs &aim m -
1
Address (number and street, city: state, and ZlPoode)
I VALUE I HOMESTEAD
ASSESSED
ASSESSOR USE ONLY AT 100% OF TTV I VALUE VPLJE
I TRUE TAX VALUE
Land not exceeding 1 (one) acre immediately �'"`%`*,:.3�•< ",�'?>'+"
surroundin residential improvements. (1)� -• - -*' » `s''U-+
Other land
(2)
'4x Gib_'
Total land (line t plus line 2)
(3)
Dwelling
(4)
- _ -sue «>�E'z`•+5`!"r «si
Residential improvements or Annually
Assessed Mobile I Manufacturetl Home
Garage
(5)
Other improvements
(6)
Total improvements (line 0 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60% of the assessed value of the homestead or, 645,000
Notwithstanding any otherpmvision, dre sum of the deductions provided in IC 61.1 -11 to a mobile home that is
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not assessed as real property a to a manufactured home that is not assessed as real property may not exceed
one -hall (12) of the assessed value of the mobile home or manufacturad home.
Signature of Auditor
Date signed (month, day, year)