Homestead_Gowin ZCLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-0g) HC10
;� Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. _ b
/*L/,G fi _41 ,1/f I_ - CERTIFICATION a{4TEMENT - ?
I(We) / litrar�IU"LI<<r nLei(,I1l!/'A certify thatPl4' a :�1 •.1f is my(our)principal
place of residence or am(are)buying the following des°fired 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): r
❑ 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.
-. w tea,. : -->�<A=. x_:=o ; -.., _ ,CLAIMANT'S:INFORMATION__ , .. -�--=- kitr'.=
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number I Page
.1
R +' - «r PROP RI - - - _ _ -
Gou;l Township Taxing district(city, to hi q) /1
r • 11 •
Parcel number Legal description Is the property in question:
0471 4-I&1 —oW. �l t� seal property III Annually ass 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.
_ ...� _ _._ s _ .. _. - .- • ,
. • _ _ PROPERTYOWNED,BYCLAIMANT IN OTNERCOUNTIES. - -- ---
County ire Township County Township gnr ofAZ
I hereby certify the ave statements true,correct and complete. ` ` ( /14/
Address(number and store city,state,and ZIP code)
e t r' -. •C0� 0410' 7 7_.
ASSESSOR USE ONLY. - rTRUE TAX VALUE d ASSESSED VALUE I HOMESTEAD I o NON-RESIDENTIAL '
• A 400%.OF.-TTV-_ VALUE . - -VALUE.
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 plrs 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)
' . 1 _ 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/C 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
on (1/2)of the assessed vat o�f�the.mob/iq home or manufactured home.
Signs of itor i��/ � Date s9n ( th. `a