Homestead_Fuhs (6)C
CLAIM FOR HOMESTEAD PROPERTY TAX
$ STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5073 (R1216-09)
'a ,•„ 1 Prescribed by the Department of Loral Goverment Finance
INSTRUCTIONS: See reverse side for MN instructions.
FILED
(�R ^L YEAR
H�1'Q9 4 009
GIBSON COUNTY AUDITOR
LWA
CERTIFICA71ON STATEMENT
I (We)
ce Y that I ( we ) occupied as my (our) Principal
place of residence or am (are) buyin a follovtln escrihed real property for which a Homestead Property Tax Standard Deduction is hereby claimed
contract on the date this appl bon is filed, (date of filing):
p1under
OL I (We) own ❑ Am (are) buying under recorded contract
❑ 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 personal residence trust
INFORMATION
Name of claimant (leg ante)
o er u
Sodal Security
� n e �-tx
Social Secrmty number of
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township
Tardog di ryyFMrtrfitV119fi�
Parcel number
tag I desaipu' /q�� �j Q Is the property in question:
—
V / I
property ❑ Annually assessed mobile home (IC 6- 1.1 -7)
If any portion of the residential structure or the laid not exceeding one (1) acre that immediately s Irnd t structure is used to produce income, describe the use and portion
of the property utilized to produce income.
2)&-ZO - l�- /00 -� l• Q�fd -�
PROPERTY BY CLAIMANT IN OTHER COUNTIES
.
County Township County
Township
1 hereby certify the above statements are true, correct and complete.
Stgnaturqrclai ant
x
Address (number and street, dry, slate, and LP code)
��7`
s 9 o E. S (o .Vc 1N
�/
6
ASSESSOR USE ONLY
Land not exceeding 1 IF acre immediately
surrounding maidemial im rovements.
Other land
(2)k'
Total land (line 1 plus line 2)
(3)
Dwelling
e
(4)
-+..s r s y ve;v rte,
Residential
alimprovements or Annually
Garage
5
()
NS'
Assessed Mobile I Manufactured Home
.. ix %i�;°
Other improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD • r
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprovision, the sum of the deductions provided in IC 6.1.1 -12 to a mobile home that is
$
not assessed as real property or to a manufactured home that is not assessed es real property may not exceed
rte- haH(12) of the assessed value of the mobile Pome ormanufactu ed home.
gna o
INr
Date signed (month, day, year)
LWA