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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD /SUPPLEMENTAL DEDUCTION
'3� State Form 5473(R13/12-09) - HC1 O
.. Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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I(We) W � — t ! ( _.�!/!•cif 4 certify tha f1 ( el ipt fr rind pal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under tract on the date this application is filed, (date of filing). I(We): APR 2 5 2014
Own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation n
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal re,A
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
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6�irs � 1x SIIC�-�i.n3.kut^�.� �T�'�id.3 1 ?W r- 3YC.:_f4�N1,.-v.a'. %i
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
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minty Township - Taring district(city,town,township)
aAJareel number i _ /,,/ �.1{/�I �/� fk/ I desatp- Is the property in question:
— I ` I2-✓V i'W b• 1°3 ❑Real property ❑ Annually assessed mobile lime(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.
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County Township County Township
Signature of claimant .
I hereby certify the above statements are true,correct and complete. ` _e
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Address umber and street,city,state,and ZIP code)' r iJ -l 474 7-0
! 0 =a LASS SSOR USE-ONLYi71:4 .t4 TRUE TAX-VALUE IASSESSED VALUE dHOMESTEAD �.(a fly y .4 VA UENTIALft',. ie
yr 1 .;- wmr„./ ,,,.J..,.r,-.,-, - tlig_ e. a - rarsaii`wATa100%1OFSIT,V}:s.._�.3VALUE `t- . c sr i,VALUE tt ?n,.
Land not exceeding l(one)acre Immediately (1) , - > -
surrounding residential Improvements. - - -•-.=,-7
>
Other land (2)
Total land(line f plus line 2) (3)
Dwelling (4) .44 iss;Ch' 4 zr -Residential Improvements or Annually _ *.";:',.%-
Assessed Mobile I Manufactured Home Gage (5) ` 4.:, > y;w{ 4 .
?ate..:`.
Other Improvements (6) s:
Total improvements(line 4 through line 6) CO
Total value (line 3 plus line 7) (6)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Veifying action-Signature of Auditor Date signed(month,day,year)
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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 Audits _ _ Date signed(month,day,year)