HomeMy WebLinkAboutHomestead_MooreCLAIM FOR HOMESTEAD PROPERTY TAX F YEAR
3 ? STANDARD / SUPPLEMENTAL DEDUCTION FORM
Sr _ State Form 5473(R12/609) HC70
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for rdirg instructions. FILED
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CERTIFICATION STATEMENT
I (We) T e v6 q— C �@N4 til3f I Wbc= as my (our) principal
place of residence or am (are) buying the folloMng described real property for whic a Homestead Property Tax Standard Deduction is hereby claimed
g er contract on the date this application is filed, (date of filing): ✓'I
I (We) own ❑ Am (are) buying under recorded contrail
Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR.
❑ 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 claimant (legal name) ((��
_T
ChQe v o r MOOt - -e
number of daunant (last five dg3s)
Drivers license I Identification / Order number
(swing Stat
'
of claimant (fast frve digits)
Name
dam's spouse (legeinam
ioaI x100
Lt
r r 2
Soda) Seamy nulmmber of 4nanrs spouse (LW five digds)
Drivers license I Idenhfcation / Other number Iswbrg State
/ 1k//
of claimant's spouse (last five digits) • , `
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contrail is recorded Record number Page
PROPERTY
County
Township
Tax'ug disin -(city, own, t ip)
Parcel number
L a tlescnpton
Is the property in question:
Real property ❑ Annually assessed mobile home (IC 61.1 -7)
any portion of the residential structure or the land not exceeding one (1) acre that immediately surma rxfs that strucam is used m produce Income, describe the use and portion
OlIf
af the property utifaed to produce income.
-goo -moo
PROPERTY
County Township County Township
I hereby certify the above statements are We, correct and complete.
Sig re of imam
'
ress(numherareet, s le, and ZIP code) i
[
OI RI-11 61
ASSESSOR USE ONLY TRUE TAX VAi.ilE' ASSESSED VALUE HOMESTEAD
NON-RESIDENTIAL
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Dweilm g
4
()
1•F�Ys --'s. `i'� `"'� a?+ � �c s
Residential improvements or Annually
Garage
Assessed Mobile I Manufactured Home
Other improvements
(6)
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
Data signed (mouth, day, year -
and complete.
Venlying action - Signature of Auditor
Dam signed (month, day, year)
STANDARD
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Nolwithstandirg any otherprovision, the won of the deductiaa provided in IC 61.1 -12 to a rnohr7e home that is
5
not assessed as real pmpeny or to a manufactured home that is not assessed as real property my not exceed
one -haft (12) of the assessed value of the home rma ufarrured home.
Signatu of
Date signed (month, day,
-ao-yea
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