Homestead_Tomasetti :e ICLAIM FOR HOMESTEAD PROPERTY TAX YEAR
. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-14)
i Presented by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Sewnry,drivers license,state identification and federal identification numbers are ranfdential -37. -_ ;_
CERT1FICATION STATEMENT' ' 1 "I-=7 1' 1.34-t' -i( '.!
I(We) i' /� �a1a '- i` Jr certify that I(we):.. pi .• o.' . ::.
place of reside y -or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of seal inO115
ID Own. ❑ Mn(are)buying under recorded contract. in O15
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified p st
I
1:1 Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY A I .R
. - -- - ?
i-
If buying on contrail Fee simple owners name
Recorders once where contract is recorded Record number Page
s: r.t- rF-� • -�-.-� 14� .- a.s PROPERTYDESCRIPTION 3 at-' __ ,',-ice_[ 39
County Tnvmsfip Taxing district(city lawn,townst p)
Parcel number I Legal description Is the property in question:
Pith i a7.i-IQ o'•1,2( ❑Real orcoeny ❑ Mnua%assessed motile home(IC est 1-7)
If any pu-mn of the resider al structure or the hand not exceeding one(1)acre that mmedia:ergg surrounds that structure is used to produce income,describe the use and portion
of the progeny tilted to produce income.
aCo -Oa- d7 - loo - 0o3. Co YG - an
PROPERTY OWNED ELSEWHERE BY CLAIMANT
sae,Cary,and Township Is daimant vacating a homestead?
❑ Yes ❑ No
)(Signet clamant
I hereby certify the above statements are true,correct,and complete.,'
1 of coma(number and tree!,car..Cate,and ZIP codas' I I..t Ue te-' I Address of sated homestead,d any(number and street.ray,sate and ZIP code)
Irw\lV/11\ y0 fF Lead few I t-9
Land not exceeding one(1)acre Immediately I(t)
surrounding residential improvements
Other land I(2)
Total land(line 1 plus line 2) I(3) I I
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)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(priors,day year)
and complete.
Vedyig action-Signature oa Aud'a Date signed(month,day,year)
-_ —,..- r+s-_- :_ STANDARD DEDUCTIONALLOWANCE- 7. - _ s�..i-, -"- - 'z -_.._=�' _'.
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 6-1.1-1210 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(12)of the assessed value of the mobile home or manufactured home.
Sg^/atxre of Aud'orr , ' AA/t4114- Dale signed(moth day,year)
DISTRIBUTION: Origaal-Cary Auditor,Fie-Damped Copy-Taxpayer