Homestead_Tolley t....t, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�; STANDARD /SUPPLEMENTAL DEDUCTION
-‘ State Form 5473(R13/12-09) HC10
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Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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a�',r�.� '�'--��y�'`'.�-�'��-gip CERTIF.ICATIOIJ STATEMENT aai�;�pp1�'I�r(� '' tA��3�i`�c�-�c�°
I(We) _� Y_WAa\ VAIN_ certify that I(wel sampled -t C (our)principal
place of residence or ( (are)buying the following des 4-. real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ 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.
r +'r�ilfr:'`c,�,='?t�,ac Pv� ita " Tlx `wS r;, }-.�` CLTAIM I∎1 S'INFORNATION P .s -ifat . 3?:�. Cift +=1..ci2Wi 'i
.S ..r,.z.-.�� a'.- +�tteyri'+ais. +�L�!£i: y !
e,kt-q " e Mei9
If buying on contract,Fee Simple owner's name
Recorder's office where comma is recorded Record number Page
ceG+,lgir .ka.,t y.ra' u` afigf� et's..•. PROPERT.Y,1D'ESCRIPTION"k3Ziarr',s tN;,` n",+n-s' •'"•r't'+dirtiin?d:,t . 3i 'd.7. i . : k
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Cou . Township Taxing district con,t wnship)
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P noel number Legal description Is the pr in question:
3a�1�-q�)3i( • ay 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 sunourthhat structure is used to produce i come,describe the use and portion
of the property utilized to produce Income.
iice�,, rt xs+ .; ,,.' rt' T"" ° PROPER171:77N75, MI MAST- TIETHER4COlJNTIES% +1"S_i' -545- t5. ti a/4,:a
County Township
I hereby certify the above statements are true,correct and complete.
/ tan�rI•n •
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Address(number and sheet city,s a,and ZIP code)
a o .• o . en V_ Re l._ • -\- • q7 fi
f T a-r *i ASSESS uSE"i(iir- Hstxt'`t'F "Bvessi TAXiVAL'UE}•I1SS' SS, OFJTT E 4-7.5 ESTE t' & 4YccNON.RESIDEiiii3O 2
r? zt§-u.t oRa UwSE..,ONL_ ::rot`> tait'.-o, . � �it ATd100%10FatT,VA ahNAL•UE . 'ss�._ asVALUE L tAC?st__
Land not exceeding t(one)acre immediately (1) 'R .,t ,..i. r ,_
surrounding residential Improvements. , f
Other land (2) = -
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually
Dwelling (4) rt .t .+. .. �i'=
Assessed Mobile I Manufactured Home Garage (5) , c:.' r cc,-.--72„P -t-, _`.
F'.
L R
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus 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)
ittNir Eltni ' .. ..iFtdYb' } $TANDARDriDEDUCTION ALLOWANCE' S-`c liSt "" iatiti..^_3 t,3a"1"ii:°'`
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 sled as real property or to a manufactured home that is not assessed as real property may not exceed
one-h l(12)of Me assessed value of the m obde home or manufactured home.
,,i , Date�s�aaz
sigma of 'tor
A