Homestead_King (3) I
MTY AX YEAR
4_ '• STANDARD CLAIM FOR/HOSUPPLEMENTAL ESTEAD PROPER DEDUCTION T FORM
S• State Form 5473(R13/12-09) HC10
°' , 1 Department by the Depanent of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 1 1 .1
i
-�` CERTIFICATION STATEMENT I(We) N/ " i • a AA!� ccf1errtCti((v th�1aittffI(we)occupied as my(our)principal
place of r/.idence or am(are)buying the following des IN d real property for which a Homestead PropUtytTa1S arKpU Deduction is hereby claimed
under co act on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract
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❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporatioGIBSON 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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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-. k7ttar'i> PaT v w-..- , ar, '`. "t iCLAIMANT iS11NFORMATION'ir.-.ts. .:- T at.-_ _ - v
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If buying on contract,Fee Simple owner's name
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Recorder's office where contract is recorded Record number Page
_ traS - - .-, ora,_ - MFRO«PErtYO E SCRIPTION.-.._r. "__ L.m °.. - . _ 7. -._
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County Township Taxing district(city,town,township)
rcel nu r Legal description ;(�(]/{) ��j`',1"�/�� Is the property in question:
I -I3 _if 03 ODD•! 3(-Da )' 11�U° ❑Real properly ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acr i(rl t immeeedddi��ately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income. - _ 47
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,:-.{ _.„ , T. = PROPERTJSOWNED BY�CLAIMANT IN'OTHER'COUNTIE&- _; "-,.- 4Z-7
County Township County ( Township a
Signamr f claimant I `
I hereby certify the above statements are true,correct and complete. �J!y�e..,,'�`/�
M. e s(n mber and street,city,state,and ZIP code) x ` I v
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_ >•1 • - _ ts _ I 1 �� l Z ' I
r ASSESSOR US ONLY I TRU.TAX VALUEd'fi'SSESSED�VALUE I 'HOMESTEADI NON RESIDENTIAL '
-USE'� � 3eu= .pae.irVALUE�c. - .?
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/Manufactured Home Garage (5) I
Other improvements (6)
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)
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�ti��_''t,�,x, aSTANDARDDEDUCTION�ALLOWANCE,�-- ���_� � __«_, f,
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real properly or to a manufactured home that is not assessed as real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)