Homestead_Birge (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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�, STANDARD/SUPPLEMENTAL DEDUCTION FORM
02::3,--" State Firm 5473(R13/12-09) HC10
—` Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. IS
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� ;s, f�'���z;4r�y''v�." CERTIF.ICATION;S TATEMENTy'�y-¢.y`�4:'-+.,.,• �ri,z�, t:71.
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I(We) / /I "aWt t - certify that I(we)occupied as my(our)principal
place of residence or am(a+j buying the following descri•-f real property for which a Homestead Property Tax Stand &Dg*tipC hereby daimed
under contract on the date te s application is filed, (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract ,/k
0 Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBSON COUNTy �
Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence a fstUDITOR
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
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��}; CLAIMANTg SiINFORMATIO �"�° `�ek»'trb.,'_iM1l :.:1.. 2uf�.._..'.�''.�-r'T'x�..37i
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If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded y�� �r Record number Page
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_" .°'' .� z+,�-•' '�Ir; r.'nr PROPERT,�Y„DESCRIPT ON�.` 'se�s. : 'i".�c�S,w 3�F�,_.ti>��5.._?i�i.��a`P��.'�*.4 -�'
Township _ _ Taxing/ (city,towy rownsn'.
County Parcel number L I desutptlon /���,�,.4..fo • Is the property in question:
/41,11- .(({2er 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.
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€'"*"+� 3'"�� °� r=�• r ;q PROPERTY OWNEDBY CLrAIMANT'IN,OTHEF2¢COUNTIES '�''�"I+ ""`'r''�f x.`a'P "�,.,. n "'-'�
en'°`w"�'t�<"�s.�.-_,.e�svi�� :� 9'''4��., ..r/ ' �._1 ._. . s�SS.x.�i c_z1'1,oa�.c.__i,ro`m^s-EFL+.�sx�'",e'a:,1:`�.
County Township
I hereby certify the above statements are true,correct and complete.
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Address(number end street,city,state,and ZIP cod
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`tsre,- t`+'" ,yrag4 ety tr s ttR.7' -.5u i"`'i y" ASSESSED VALUE,` eHOMESTEADi4 ''? NON-RESIDENTIAL{ -:t�
gistel-S.DSO,R�115E;.ON Y t glib RUE TAX VALUE� ATa100/OFe-fist-t2 ar.Iv1VAlitlEof' 'tai tc VALUE Z'4Z ±i¢
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Land not exceeding I(one)acre Immediately (1) i.. I : �. 'i.
surrounding residential Improvements. _
Other land (2) _.-
Total land(line 1 plus line 2) (3)
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Dwelling (4) r ii ii.lci..., I r cc ' -f
Residential Improvements or Annually
Assessed Mobile/Manufactured Home Garage (5) i:"y.;i. , __ .-'1'
ii ti. iit:;,.J 5.
Other Improvements (6) ...,::27:
Total improvements(line 4 through line 6) (7)
Total value (line 3 plea line 7) (8) .
I 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)
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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.
Signatu of Auditor /kQ/ :cc.) Date signed(month,clay,year)