Homestead_Redman (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD /SUPPLEMENTAL DEDUCTION FORM
' ,•'• , State Fonn 5673(Dep/12-09) � -
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. -
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I _A • CERTIFICATION STATEMENT .
'e) A. 'SIT let •d• certify that I�V
Cn e)occu ied yjtSur)principal
•place of residence or am(are)buying the following described real property for which a Homestead Property Tax S is hereby claimed
under ct on the date this application is filed, (date of filing). I(We): GIBSON COUNTY AUDITOR
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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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'. t .'i. • '. ->_ -•-< ; • •a eCLAIMANTSINFORMATION< :: .= ,�1,- -> i.: .6`„su ',,
---me of d imam(legal name) r�
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Name of claimant's spouse(legal name)
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)e:
If buying on contract,Fee Simple owner's name - a
Recorders office where contract is recorded Record number Page
.I•- - IPROPERTY DESCRIPTION - -
County Township Taxing district(city,town,township)
reel number Q at ,.�e� Legal description Is the yfOperty in question:
IU - 'v� L.� /78 g ®®®Real property ❑ Annually 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,describe the use and portion
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. Si. ature,pf claimant i1 `
Address( tuber and street, •I r�,slip and ZIP code)
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ASSESSOR USE ONLY_ • .I TRUE TAX VALUE/l ASSESSED T 900E OVVALUE HOMESTEAD I . NON- E DENTIAL
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) •
Other Improvements (6)
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Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor - Date signed(month,day,year)
I 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$45,000
Notwithstanding any other pm vision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed 14\
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)