HomeMy WebLinkAboutHomestead_Burton nr CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a_.i`A STANDARD I SUPPLEMENTAL DEDUCTION FORM
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�$i;p. Sate Form 5473(R15/5-14) HC10
•�°'%/ Prescribed by the Department of Local Government F
INSTRUCTIONS:See reverse side for filing insUUcbbns.
NOTE:Telephone,dial Security,drive's license,stale identification and federal identification numbers are confiden-..- - t. -12-'•.
CERTIFICATION STATEMENT'-
I(We) jIZ century that I( ` o •-•••"-.`; .. • ..al
place of r sidence or am(are)buyi ithe following described real property under contract for which a Homestead Property Tax Standard
Deducti•n is hereby claimed on the date this application is signed, _ (date W E1 falOre). ant
❑ Own. ❑ Am(are)buying under recorded contract. JJFiiY O ant
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. n,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terns of a qualified d6�» a trust
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY A :
Reader's o5ce Mere mitred is recorded Record number Page
i--Z. '` lc; _ _ �r'PROPERTYDESCRIPTION n�'d2a'..%ay_1..'ca? :`.;•
County -- - Townships Taxing district/ town t/ `�✓nshM) • _
Parcel number Legal question:
desolption Is the property in qstion:
5.J` AG 0 I I i ❑Real property ❑ Annually assessed retie home(/C 6-1.1
If any patios of the residential srJCJre or the land not ex¢Wng one(1)acre that immediately surrounds that 5t1-Icon IS tad to produce'income,deso'be the use and portion
of the property udaed to produce income.
• 2. (0- / a— at,/ 6/- 9y8 - 0 ). '
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is claimant vacating a homestead? I
0 Yes 0 No
..n;atu: !claimant
• I hereby certify the above statements are true,correct,and complete.
.4 •
of canact(number and s'mer coy,state,and ZIP code) -I ,tress of vacated hoxstead,d any(number• • -L coy.stare,and Zlin code)
�r6 I I
Land not exceeding one(1)acre immediately (1) '
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements 1(5)
Total Improvements(line 4 through Tine 6) (1)
Total value (line 3 pits line T) 1(8)
I hereby certify the above is true,correct,
I Signature of AScessor Date signed(maned,day.year)
and complete.
Verif g action-Signature of/ue::or Date signrd(math,day,year)
;3 .'STANDARD DEDUCTION ALLOWANCE 5_x-.' _ tt-,_;$'{e�-;zitrci
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real properly or roe manufactured home that is not assessed as real properly may
not exceed one-half(1/2)off the assessed value of the mobile home or manufactured home.
Sqarm Date signed(=ea day,Year)
< / 3 C
DISTRIBUTION: Original-County Aud:o,Fie-Ram Taxpayer
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