HomeMy WebLinkAboutHomestead_Chamberlain (2)" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Fonn 5413 (R13112-09)
ru•
! Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
I (We) certify that ) ied a ( r) 'pal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax da imed
ier contract on the date this application is filed, (date of filing). I (We):
OCT 2 0 2���
Own El Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation C.13 1
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residences
❑ Am (are) the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
Name of almant (legal ruin)
v
Social Security number of dalmant (
rooJdaimanYs
Social Security number spouse (last IMi dgds) Drivers license I Identification l Other
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number
Page
Coin
Township
T district (tity, town, township)
Parcel number
Leg! ascription
Is the pmpery in question:
❑ Real property E] Annually assessed mobile home (IC &1.1 -7)
arty portion of the residential structure or the land not exceedmg one (1) arse that immediately surrounds that strumre is used to produce income. describe the use and portion
f the property utif¢ed m produce income.
®- oiF -�,y. 303- 000,
County Township Court' Township
I hereby certify the above statements are true, correct and complete.
Sgnw of claimant
,-Address (number and srreel, city, state, qFjd ZIP 0000) /1
'209 c��s!/„'•�
Wart
Land not exceeding 1 (one) acre Immediately
surrounding residential Improvements.
Other land
(2)
Total land (line 1 plus lure 2)
(3)
Dwelling
(4)
3 Sra
Residerttlal Imluovernents or Annually
Assessed Mobne I Manufactured Home
Gara ge
($)
i �_ ros"mi•Sn- :,r"`t�.dc` =,.•«" �=,
Other Improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus litre 7)
(8)
I hereby certify the above Is true, correct,
S Inamre of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwimstanding any orherprovism, the sum of the deductians Pmvided in IC 61.1 -12 to a mobrfe hone that is $
root assessed as real property or to a manufactured horn that is not assessed as real properly may not exceed
one -haft (12) of the assessed value of the mobrfa home or manufactured home.
Signature of Puditor
Date signed (month, day, year)