Homestead_Mosley !fi+_-;i CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
4 STANDARD 1 SUPPLEMENTAL DEDUC�i-4 �� NC10
icd� State Form 5473(R73112-09) FF��-i1
Presented by the Department of Local Government Finance s� T
INSTRUCTIONS See reverse side for filing instructions. 1 ��q'� �- s
F 3;i rp. cwt17aiS�tr ari -^' • , _ CERTIF,ICATIONISTATEMENTgalyym '.y.'-,..`ii�J3°,r''Weital ..'' j' r'r�.'' ii'n{' 1:?.
I(We) IA_ . r'lWt I-�. L - r. S /t_. certify that I(we)occupied as my(our)principal
place of residence or am(are)buying thy ollowing described real prope - .lintf'-7t",-stead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, GIBSON COl a16f4LMF))Ti ):
wr ❑ 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
❑ aA�m (are)the shareholder, partner or member of the entity that owns the property.
"'te-_ Y.-•usx_ '- 219-M- Salt EKG'. - FL* 3' •ti ,� y". ,-viS'. ,
S. -a€e��� CLFAIMANTj SIINFORMATION�'j�e^s�rer�`+^�"' +t,a7irc4�t.L'�.wz"'`L�it' ;a.'1+ �>�'=t-f
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
;, faifi 92°.>/.: h"4-a -r- t .^�-+p'¢, s •"'-i -r Y-.-'f.R" r-'� \5 i-..t"'e
� �s:;6��"3Xtx3 ?y�°:'�-.����'LIt� P,ROPERTrY.'DESCRIPTION,ge�` v,;,t�.'tkf-.zt"�-�`i�S -., �`:z'c.3:;�5�"�S�}', �j4:.?�°
County Township Taring district(city town,township)
�Px�/L�I nu r g /''y�Legal d Lion Is the property in question:
C� � —i 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)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
.t Waam-i,? aSata „-pr=P lib PERTrY:gWNEDrBYiC LAIMAhTo;OTHEcCOUNTTia .Stlirigatac-
County Township County Township
I hereby certify the above statements are true,correct and complete. ^ =tune ofd ' ant l.l- (�
Address(num. Icdy ci state,and ZIP code) 'M• - IM11.17
i
t^4, C 4 SE$e R ra'ac Lt h - q TR VAL ASSESSED VALUE Iz`HOMESTEA . .>; `.z-"',-,.NON RESIDENTIAL..
r..ti -4d_s._.rcvby.Rtus ..upy k,c,l;� a =Aril 00'/o�OFaTiT,Vtfl- iVAL•l1E'.�� k x + '{i VALUE iR- + `- `t-
Land not exceeding 1(one)acre Immedatey - F
surrounding residential Improvements. (1) t " '"
Other land (2) :
Total land(line 1 plus line 2) (3)
Dwelling (4) s S ar k 4.- £°
Residential Improvements or Annually
Assessed Mobile/Manufactured Home Garage (5) - hf _ --rift::
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
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.
Vaifying action-Signature of Auditor Date signed(month,day,year)
-... � 'fit?-. -IF.l ai- irlaSTAND&M DEDUC,16$174 LOWANCEW r 'V•4.S:,,rp�j;'a t1'" € t x' d`3 / ,�.���{1yy�"e
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any otherpovision,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 ed(month,day,year).