HomeMy WebLinkAboutHomestead_Clark (7) M A CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_ STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15 1 5.14) HC10
J Prescribed by the Department of Local Government Fins � ! f
INSTRUCTIONS:See reverse side for tiling instructions. `7 a
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❑ Mn(are)the shareholder, partner, or member of the entity that owns the property. li tl5 COUNTY AUDI IIOR
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It drying on contact,Fee Simple owner's name
Recorders c°ce where contract is recorded 1 Record number !Page
County Township I Taxing n•• V,,form,toms^js.
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//''//������)///ss ry/�1.^Parcell number{/�/ ()co. /(�f�Leg(alldddeescaiip/t�/r�/�� Is the propenY in puea:ion.
1,,.{V-I Y !-VV '_ �N v�” V Real papeM ❑ Annua%assessed mob2e tome(/C 6-1.1-7)
If any potion of the residemial saurure or the land not exceeding one(1)acre that immediately surrounds that suuume is used to produce income,describe the use and portion
of the property teil¢ed to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Save.County,and Township I Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of
I hereby certify the above statements are true,correct,and complete. �(' _ /
IAddress of contact(number and street,uty,state,end ZIP ode)
n /Ad`d(ess vacated homestead,deny(number and street,ct)ma
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON�ESISIDENTIAL
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements _
Other land I(2)
Total land(line 1 plus line 2) I(3)
Residential Improvements or Dwelling 1(4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
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, I Signature of Assessor Date signed(month,day,year)
and complete.
Ve fyvg action-Signature of Auetor Data signed(mach,day year)
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NEEMEZEMESIZEIMERDI
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 S .
that is not assessed as real property or to a manufactured home that is not assessed as real property may JAN 5 2014
not exceed one-half(1/1)of the assessed value of the mobile home or manufactured home.
Sg azure• =' ^r Date signed(moth,day,year)
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1_1_ \ i 1., _L,./,..-ei
OtSTRIBUTION: Odgiw-CounyAUd:ec Faesamped copy-Taxpayer GIBSON COUNTY AUDITOR