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CLAIM FOR HOMESTEAD PROPERTY TAX / ojt UIJ YEAR
4! MAR
STANDARD /SUPPLEMENTAL DEDUCTION tit
a State Form 5473(R12/6-09) 1q
f Prescribed by the Department of Local Government Finance
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INSTRUCTIONS:See reverse side for filing instructions.
GIBSON COUNTY R
CERTIFICATION STATEMENT
I(We) //IS/!y1r.{,/J[/ n 4 7.1 — certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real pro /nfy for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I(We)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
CLAIMANT'S INFORMATION
Name of claimant(legal name) Q O 1"-�
��
eitiva
-
CONTRACT RECORDED
if buying on contact,Fee Simple owner's name
Recorder's office where contract is recorded Record number I Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcel number Legal description Is the p y'rty in quest•
Wt M4J�,� U Real property r 0 Annually assessed mottle home(1C 6-1.1-7)
If any portion of the residential structure or the land not exppeding one(1)acre that Immediately surrounds that structure is used to produce income.descnbe the use and portion
of the property utilized to produce income. .
a(o-/7- 07 - ,),00 - 00 5. Iy a _v a/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. writ re of claim / •
\ / V Andre umb:r and :d state,and ZIP code)
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ASSESSOR USE ONLY TRUE TAX VALUE l ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre Immediately 1 - - -
surrounding residential improvements. ( ) - - '77.—r s,- -']e=t_�'�.^+-'i»::aS S
v •kS.Y.;�`E��
Other land (2) it,al J.tw-;i« .
Total land(line 1 plus line 2) ,(3)
Dwelling (4) :Lrss•,:.' +xr.:
Residential Improvements or Annually
Ateeceed Mobile I Manufactured Home {t- � a Garage (5) $ic j11 � t:KF;k..
:-
Other improvements (6) ;�"=;�r� '3j�r{.r��y
.sit
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Aactor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the aseecsed value of the homestead or$45,000
Notwithstanding any other pmvision,the sum of the deductions provided in IC 6-L1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed - I�
one-half(1/2)of the assessed value of the mobile home or manufactured home.
• Sgnatu;of Auditor Date signed(month,day,year)
4 ill _A 4 .