HomeMy WebLinkAboutHomestead_Shoultz (7)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
s, State Form 5473 (R1216 -09)
'O l Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
T L E D
00
CERTIFICATION STATEMENT
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following descri pro for which a Homestead Property Tax Standardyed ioryis,ryereby claimed
//�i �� //
under contract on the date this application is filed, (date of riling),
❑ I (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 claimant (legal name)
Social Security n un
Y 2/
Name of claimant's spouse (legal name)
Social Security number of claimant's spouse (last rive i grts) Drivers license I Identification I Other number Issutng State
of dabnanfs spouse (last five dglts)
CONTRACT ••D
If buying on contras, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Township
Taxing dMin n wnshi
In
PnZ�
Legaldescnption-
LK —LEA/
Is the pmpeMth Westion
IL�y]}ire-a) I pmperry ❑ ua0y assessed mobile home (IC 6-1.1 -7)
any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce immune, describe the use and Ponlon
®If
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.
reg u ra I, d .crate, and ZIP
ASSESSED VALUE I - MOMESTEAD NON-RESIDENTIAL
ASSESSOR USE ONLY fRUE ��,VALUE 1: AT 100% OF TTV .1 VALUE VALUE
Land not exceeding 1 (one) acre immediatelyypryy�- c."`��, -�±°+.
surrountlin residential improvements.
Oler land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile 1 Manufactured Home
Dwelling
(4)
t- �• 'T�-'-+�'�'°'}i -'xe.-
}��
Garage
(5)
� �cT�eJ�•ra,,, �r )� -ri
Other Improvements
(6)
r = rp =•
Total Improvements (line 4 through line 6)
(7)
Total value (line 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)
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Norxi hstmoirg any otherprovision, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile home that is
$
nor assassed as real pmpeny w tc a maniasaurod home that is not assessed as real property may not exceed
one -Aaff R) or me assess value of the nabr7e home or manrdactu ed Fame.
imr
Dow day,
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