Homestead_Eads (4) Via._ CLAIM FOR HOMESTEAD PROPERTY TAX /y� FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
�t' Slate Form 5473(R12/609) HC1O
Prescribed by the Department of Local Government Finance I_1,
i
INSTRUCTIONS:See reverse side for filing instnrct ons.
- III) CERTIFICATION STATEMENT
I(We) \J ► )e/YnQAQ.-ICI• 'fy that I we)... .i=..as my(our)principal
•place of residence or am(are)buying the following described real property for which a Homestead Pro..
,r.;, tt j j'j94eduction is hereby claimed
under contract on the date this application is filed, (date of filing)GI BSON COUNTY AUDITOR
❑ 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 . (legal nna/mee)��/'�\/ '��"
Name of claimants spouse(legal name) '
•
Social Secwity number of claimant's spouse(last five dgds) Divers license I Identification I Other number - Issuing State
of claimant's spouse(last five digits)
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded I Record number I Page
PROPERTY DESCRIPTION •
Coin ,yf`'', , Township Taxing district -. , i jownship
P r�(dlnumber /'y� Legal deessaipdon Q Is the p in question:
'CT �t � �O�_O 03. I�� (J Real property ❑ Annuaty assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,descnbe the use and portion
ilhof the property MI/zed 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. signature o/f/(aam ,p /J
Address(number and street,city,state,and ZIP code)
c C4 1. • '4 c o '7 Al
I ASSESSED VALUE HOMESTEAD I NON-RESIDENTIAL
ASSESSOR USE ONLY TRUE TAX VALUE 1 AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre immediately 'f' ' "'`- :'.°+3-,Ei'"'`" j.�" '"�
surrounding residential improvements. (1) �'.-v"�'F.`�y`�-�Y'{�;� '-�._ zth
Other land (2) P itai 44
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually -Dwelling (4) - c•'rid .n� 2- a s. 1s T_
Assessed Mobile I Manufactured Home 2.- 'L."c`1 - .x`W>ciiThj.
Garage (5) ;'. 't.+-: .- e.e '."..
Other improvements • (6) ',' .kviy . •
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.
V9dying action-Signature of Nrdtar - Date signed(month,day,year)
® STANDARD DEDUCTION ALLOWANCE•
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any otherpovision,the sum of the deductions provided in IC 8-1.1-12 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
If 12)of the assessed value the home or manufactured home.
Signs Audi Dale signed(month.day.year) '
/-dry -13