Homestead_Kimbrough """o CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
e._-, t STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09)
�' ,a° Prescribed by the Department of Local Government Finance s g !INSTRUCTIONS:See reverse side for filing instructions. rxy V 4/5 f I (�O3 I I ,'
o CER TIF,ICATION STATEMENT
I(We) ittnaiI O ��� _ ... f r/ certify that ('7t of upi ili= my(our)principal
place of residence or am(are)buying the following described real pe,erty for which a Homestead Property Tax Standard Deduction is hereby claimed
under con on the date this application is filed, (date of filing). I(We): .4144:cclkzeir
n ❑ 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
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
° CLAIMANT'S INFORMATION -
o CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
I _ e PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcel number Legal description Is the property in question:
(9(9 ' /a.") Ii - 1 DI- D03. 33d i:628 ❑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.
err PROPERTY OWNED' MOTHER COUNTIES o
County I Township County I Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
ress(number and street,city,state,and ZIP code)
fl l S. /(/ . 2, 5 r ' , -4 — 4 760
ASSESSOR ! ONLY a m! 1 VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIAL
ASSESSED.a AA T- L 1
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)
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 provision,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 property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)