Homestead_Sefton ;t3._ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
:4�' •:A STANDARD / SUPPLEMENTAL DEDUCTION FORM
•" State Forth 5473(R13/12-09) HC10
• > I
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions. i 1, ! ilk:
"V// ii_° �1 D �r:- CERTIFICATICri,STATEMEtIJ, - • �. :_:
I(We) y� tI7 I ' ��r W17W/ 4%IF r certify that I(we) ', piedd as my(our)principal
place of residence or am(are)buying l4- following described real property for which .1 omestead Property Tax Standar.�1-UuAcin i2Ocithby claimed
under ntract on the date this application is filed, (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR
❑ 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.
-, . : _-1 rte_._. ._Nc. Iliit _t _"_� .- .. r -
.°. � 4 ..'�+`a:.�C'L'AIMANTSINFORMATION�- .._� µ«-_ . �' _d� c� . r: <-
_. �dY'. `.-.
_...CONTRACT RECORDED.3 __ s±... ■ a: x,.- .�.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number I Page
I, "7 - .: 5 s P.ROPERTY DESCRIPTIONS .. - ...�r! . -
ICoun `��•i ' Township Taxing district(city;town,township)
pig. n, _" yxx, '1. lypr�,I c °— n Is the property in question:
�( O�.(J - OI-. �f�/�+' (l• 7 - - I ❑Real property ❑ Annually assessed mobile home(/C 6r1.1-7)
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.
• PROPERTY;OWNED�BY CLAIMANT IN OTHER COUNTIES Y� :
._ _ice ': . .,. _- �:
County Township County Township
I hereby certify the above statements are hue,correct and complete. Si�natur ep/§%dj�im�ajm� /j
dress(number and street,city state,and ZIP code - '/ / '/ • --
//ia-- o I< l o c.Ae> t • P7a.1. x -IA t/763
ASSESSOR USE ONLY - I TRUE TAX VALUE .I AAT 100 E.0f4,TTVE I -. VALUE: �I NON- VALUENTIAL ' -
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/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus 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)
• -- - - 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 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 1/9)of the assessed v- ue of the mobile home or manufactured home.
Signature f ditor ) Date signed mon day, ar