Homestead_Schleter n CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4._ _i l STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5423(R15l5:.4) HC10
Prespbed by the Department or local Gwemment Finance '
1
INSTRUCTIONS:See reverse side for flung instructions. °, I,?
NOTE:Telephone.Social Security,driver's license,state identification and federal identification numbers are confide . tin•_�t • . -1 - .
- .:(J; n - • .'/. '� - 'CER�TIFICATION STATwME-n-n :lam(/ -- 'II((��tt,,�� qq p -
I I(We) _ea ata-r i1 errarire , •th. l(we)ca l% 1 roy--1 ..rindpal
place of residence or am(are)buying the followi J described r--'•roperty under contract for which a Homestead Property Tax Standard il
Deduction is hereby claimed on the date this application is sign-•, (date o}ignature I •
Own. ❑ Am(are)buying under recorded contract.
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.GIBSON COUNTY AUDITO
❑ 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.
` - :. .CLAIMANPS INFORMATION,: - ::::',-7.-
aY
Recorders office where peuad is recorded Record number I Page
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'_ -_,z a..-^_ s.:z�.�'.=_l-- i `-R-_ _. .PROPERTY DESCRIP770N.'-ct�.``.'cE-CC'�� .��''���{�//�. c4=.5'.
County ITOwmhip� Tasug dsaid(city,n a /
PaK I number /�/�-000.103,0 Legall dessotption (/ Is the property in question
OlC9-- f 133.,/4 w -)0T al yOPent ❑ Annually assessed cootie Mme(IC 6-1.r-T)
If any portico of the residemal=inure or the land not exceed g one()ape that immediately vnounds fA at=turn is used to produce umme,destnbe the use and portion
of the property lazed to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
sate.Casty.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
1St -ofd
I hereby certify the above statements are true,correct,and complete.
s
Address clad(numtm and greet day.state,and ZIP code) y� Addre:I:va I-ed. .es,ead,d any(nu and great sly,vote.and ZIP code)
I . Cc —71i )1(C I 1 to' (
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (1) I
l
Total value (line 3 phis line 7) (6)
I hereby certify the above is true,correct. Sgw:ure of Assessor a: d I .deg geed
and complete. (�
Verifying action-Sgnaaue ofPW::a JAN 30=57gra,.day,year)
__ --1-t7'-r. _ ' C STANDARD DEDUCTION'ALLOWANCES UU ��11�� �,=r: '
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 '---I � C�rnlfia
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile toms ON COUNTY AUDITOR
that is not assessed as real Rmperly or toe manufactured home that is not assessed as real property may
net ex• •'•n: all(IR)of the arse •=r value of the mobile home or manufactured home.
Sgta'.ae .: Dro i ned Aunt&
D deyye y 1 41 DISTRIBUTION:Original-County Auditor,Fie-Samped Copy-Taxpayer