Homestead_HelmbockCLAIM FOR HOMESTEAD PROPERTY TAX 1'II� YEAR
STANDARD /SUPPLEMENTAL DEDUCTION •G HCRo
State Form 5473 (R12/6-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FILED
0
I (We) certify th ) pied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (we) own ❑ Am (are) buying under recorded contract
GIBSON COUNTY AUDITOR
(are) PY P 9 rporatron
❑Am are entitled to occupy as a tenant - stockholder of a coo erative housing co
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of daima enna
Social Security number
Social Security number of claimant's spouse (last five digits) Drivers license I Identification I Other number Issuing State
of claimants spouse (last five dgits)
CONTRACT ••D
If buying on comma, Fee Simple owners came
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
Cou
Township
Tang district (' ,own, to ip)
�number 7
—
al description
Is he prop m question:
eel property ❑ Annually assessed mobile home (IC 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and pardon
of the property utilized to Produce ocom
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township Ccunry Township
I hereby certify the above statements are true, correct and complete.
S of ai
G)
Addre ber street, city, state, and ZIP e) w X666
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD -NON-RESIDENTIAL
AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre Immediately
surrounding residential improvements.
rui•
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
t or Mnualty
Assessed Mobile Manufacture
Assessed Mobile I Manufacture d Home
Garage
` ryti,v�0',XT+ ter:
(5)
Other improvements
(6)
x t'Y
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (mmth, day, year)
and complete.
Verifying action - Signature of Puditer Date signed (month, day, year)
®
STANDARD
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nohvitlstarding any onerpmvision. the sum of the deductions provided in IC 6- 1.1 -12 to a mo66e home that is 5
not a as real property or to a manufactured home N 's at not assessed as real property may not exceed
o a 1RI of the asisesied vatue of the mobile home or manufactured home.
Via itor
Date signed (month tlay, ye�d