HomeMy WebLinkAboutHomestead_Hollingsworth CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
:A____▪ ' STANDARD I SUPPLEMENTAL DEDUCTION FORM
,1 State Form 5473(R1515.14) h
• ' Prescribed by the Department of Local Government Finance _
INSTRUCTIONS:See reverse side for fling instructions.
NOTE:Telephone, a tel Security,drivers license,state identif ation and federal identification numbers are confidential under IC 6-1.1-12-37.
/f'4�� i�'�. p - CERTIFICATIONSTATEMENT _ � ' - - 1
I(We) .��7, �•tV_!l L'
to 11-Q _ L certify that I(we)octopi�t� y •ur) jI J• I
place o residence or am(are)buying the following•- ribed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this appli is signed, (date of -. 'um} I a e: . -
7•114;
Own. Am(are)buying under recorded contract. GIBSON COUNTY AUDI OR
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
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
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_'
If buying on contract Fee Simple owner's name
Recorder's o5ce where contact is recorded 1 Record number Page 2 I26‘,-'-- 'a c"--Z _ _x •—_f. - �'PROPEitTYDESoRIPTON ask�m -''.r __. 1- -?"t
, ^/ \ Township= T-,.• n
. O C) ® �l! ,- it ..C. .
Pero.center _/ Legal description Is the m- Derv'n 0tespbrt
0 a(/ 'J•�/w t /f6O./t� /} 7 s thhe P112Real property ❑Annually assessed mobile home(IC 6-t I-7)
If any portion of the --esideemial s flee or the land not e.ceeding one(II))a acre ethat immediately eda:el surmuWS that Itrucure is used to produce income,describe the use and portion
of the popery utilized to pima More
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Srs,,{C//¢J,try,ands Teens±nio�.�{ 1 �7� Is claimant vacating a homestead?
i 21L J0? Q —F N Yes [J No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and steer cry,state,and ZIP code) 1 of vacated homestead,d any(number and street city,state,and ZIP code)
516 ri ,:11 51I g e/Cc J.,r/9 2 t GC
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESISIDENTIAL
VUE
Land not exceeding one(1)acre Immediately I(1)
surroundin•residential Im•rovements
Other land (2)(2) bolt .� �7�-' �i..a/�=
Total land(line I plus line 2) IMMIIMMIN y
Residential improvements or Dwelling rarA Lff
Annually Assessed Mobile l / /
Manufactured Home Garage
Other improvements _Mr_.FA L /�r ri
Total improvements(line 4 through line 6) (7) #ir Q, Ma
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assesses Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
n. - - .ma .:
L .. _ Wi •' -_x �: `_STANDARD DEDUCTION ALLOWANCE=� �� S', . Y:..�_ .c -.�
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Nolwrthstanding any other provision,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 as real properly may
not exceed one-hall(I/1)of the assessed value of the mobile home or manufactured home.
1 Sgnavre of Auditor Date signed(."t day.year)
DISTRIBUTION: Ongial-Oascy nuance,FieSamped Copy-Taxpayer