Homestead_Tice •
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
` STANDARD/SUPPLEMENTAL DEDUCTION FORM
Stare Fo 5473IRIS1St4) S -.
' rm Prescribed by the DepaMnent of Loral Government Finance Ts :
INSTRUCTIONS:See reverse side for filing instructions. I . • ••
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEN:HT . ' u LP-
I(We) W I71Z .flfl I//�r., ��\\�. . . certify that I(we)occupied as my(our)principal
place of residence o '.m(are)buying the following described real pro•-• i der contract for which a Homest d Property Tax ndard
Deduction is hereby+aimed on the date this application is signed, 00 (date natu
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❑ Own. ❑ Am(are)buying under recorded contract. GIBSON COUNTY AUDITO�
❑ 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.
It buying on contract Fee Simple owner's name
Recorders oSce where contract is recorded Record number Page
a
Cvy Township •Taxing d • r ryc N've vi_c ,
Parcel number "" ���� Legal desmpion Is the progeny in quesOon:
4aJ/sic,,_//17_b/_/cb ../-yy,89 I -oat) Real property ❑ Annuafy assessed moble.. (IC 61.1-l)
If any portion of the resgentul s'.njcure wor the and not exceeding one(f)ace that immediately surrou s that ssuCure is used t0 produce'umme.describe the use and portion
of the property utl6W to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate.Candy.and Township ',�`''/Iss cla❑immajntt�vacating a homestead?
' E ❑ No •
Signal of imam
I hereby certify the above statements are true,correct,and complete. -
Address of contact(number and street city.state,and ZIP code) Add of vacated homestead.d any( miter and s✓eee ay,state.and ZIP code)
I 5 - 7o0 Al 6 en) DII7C J44S/
Land not exceeding one(1)acre Immediately I(t)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements I(6)
Total improvements(line 4 through line 6) (7) I
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day yeah
and complete.
Vedyig action-Signature of AUdoor esI •( -
.: --;- _ _ i.- ' = r'STANDARD DEDUCTION ALLOWANCE:_- 7.4 -1 ::. 1-- z4i.
20 pay 20 ' Lesser of 60%of the assessed value of the homestead or$45,000
JUL 2
2015
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that not asse -ed as real property or to a manufactured home that is not assessed as real property may
not exceed on =i(1R)of the assessed vale:4 f the mobile home or manufactured home. `
I oat.. .,•- WP Ii;
IMF / �_ . _\II/ GIBSO _��.4Li�/tl� as :
DISTRIBUTION: Origial-C umy Aud:or.Fie-Samped Copy-Taxpayer
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