Homestead_DeWeese -d_�.-t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
+ STANDARD/SUPPLEMENTAL DEDUCTION FORM
is• d Stab Form 5473(R15I 5-14) HCIO
Preaaibed by the Department of Local Govemmem Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under r I r
CERTIFICATION STATEMENT - ) L-C 1 !�y ,\
I me) 41I0I ' f a-44 t si
1 . ts(we)... .,-.a .•y I i
place of residence or am(are)buying the following described real• operty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signs!! wet 2014
❑ Own. ❑ Am(are)buying under recorded contract. UU CC IL. G b
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. n I
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pe s eSid . .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIB G1�L�
ITOR
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
1- t ? F. _ _ . 3 _r- ...,_:•PROPERTY:DESCRIPTION r==e aF"t .771..1 s ,.. ,.�'T&114•'`z
Casty Tan atip I T g*strict(ply,torn,towns/10
Parcel number Legal description 0. f Boq C Is the property in Question
Pr • 1 & 1/ - LI - , ` I Deal progeny ❑Amua%assessed moth none(IC 6-1.1-7)
If any por5on of the residential atudue or the lard not exceeding one(1)acre that innedately surrounds that sttCUre is used to produce income,describe the use and porsn
of the property utilized to produce income.
2 4,— 22 -I,- too -0oo. 986 - o ,-cl
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate.Coady,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
I Sign lure Plant /
I hereby certify the above statements are true,correct,and complete. 0 -1�(I �(Y//xs
' 1 Address of contact(number and street sly Sate,and ZIP code)) Address of vacated ead,d any(number and street rdl:state,and ZIP code)
\,1-5 X, 2//! i( 25 S //gobs/SJf 9)L3c
Land not exceeding one(1)acre Immediately I(t)
L surrounding residential improvements
Other land 1(2) _ I
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements (6) -
Total improvements(line 4 through line 6) (7)
•
Tonal value (line 3 pis line 7) (0)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day.yelp
and complete.
Ve ng action-Signature of Aud:tor
4;i s.' signed i
i
d ■ lk
_». raw' • t+i irLT. ?STANDARD.DEDUCTION ALLOWANCE_`_y -'L _-4-1.4,S R- -:
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000 DEC 2 6 2014
Abtsnthsanding 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(1/2)of the assessed value of the mobile home or manufactured home.
��N AW.^,or Thad
GIBSON COUNTY AUDITOR
DISTRIBUTION: Orgi al-County Auditor,Fle-Stamped Copy-Taxpayer