Homestead_AmosIf ',Wr:y
CLAIM FOR HOMESTEAD PROPERTY TAX
6 FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473(R151 5-14) HC10
-'$' Presatbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under I . I
I(We)_ �f{/Yl 044-9—Q i&Y 'a certify that I(we)occup" as n
place of residence or am(are)buying the following oescnoeo real property under contract for which a Homestead Property Tax Standard
Dedu • is hereby claimed on the date this application is signed, (date of signatur J N2: 2O1
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 persona u;' 1.-14'ye1J;
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY
. AU DITOR
- siv _ '_--17 .o CAIMANT'SIFORMATON - -. "a: -= ,,. _
Name,"' Telephone number of claimant
�/`"�" ( )
Social sewrry...pry. (le livitiOte) Drivers license llaeMficauon I Other num/beerr��/•^J Issuing
/�
rryf`(7l /� g� of claimant(last fire dga) l 3C0/%1( r a
Name cf claimant's spouse(leg al name)
Social Security number of da'manrs spouse(last live dgas) Driver's kense r Went(Seaton I Other number I Issuing Sate
of dim
aanl s spouse(last eve Ogds)
S.;: .--.S a`?''-CONTRACT:RECORDED .2i > --�,l- 1 j;` 4-rt.- s.-a
If burying on connect,Fee Simple owner's name - _
'Recorder's o5ce where mr.tad is recorded Record number Page
s:=Tr-,,I-1 -`-'.i__�. -f _ --'=_PROPERTY.DESCRIPTION :- _ Oda 7 Q'% ry'�ix v_-
/C�a/vim' • • boo. Taxing Csr^a(alY.tam tox+W�
(9 Parcel number Legal description t2-fl2'{O'3-b o. bag Ilzlhe wgalP ), 0 Annua%assessed mobile home(C 8-1-1-71
If any portion of the residential s'.ruaure or the land not exceeding one(1)acre that Immediately surrounds Nat sttrudure is used to produce income.dezmbe the use and portion
of the property teemed to produce vlm-le.
S441 ada I%
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Casey,and Township Is claimant vara5 a homestead?
❑///Yes o
sgnavre of la m
I hereby certify the above statements are true,correct,and complete. (n,
A
Amress of contact(number and street.ow,,stare,and ZIP code) Address of vacated homestead,if any(nu •,nd street.alp,state.and ZIP Dade)I 111
. + • •I is :. AIL RSA
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or ' Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 puns line 7) (8)
I hereby certify the above Is true,correct, I Signature of Assessor Date sired(month,day.year)
and complete.
Vatfyvg action-Signature of Patter Date signed(=Mb day,year)
FTHir- x-e.--- ---ile.ire:e-- icy W -a STANDARD DEDUCTION ALLOWANCE4f,7 ems,-✓' is -4—a- 64
20 pay 20 lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding 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 reel properly may
not exceed one-hall(12)of the assessed value of the mobile home or manufactured home.
Signature of/wdi0{ I - ` 1 I , Date died(nrno,th dayyear)'s-
YidVTAIIAa jMl/t//av �ili(.F Ls` 100)\
DISTRIBUTION:Ongiwl-County Aud'na,File-Stamped Copy-Taxpayer