Homestead_Mattingly s_ _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
_t- State Form 5473(R1515.14) HC10
Prescribed by the Departnera of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Severity,driver's license,state identification and federal identification numbers em confidential under IC 6-1.1-12-37.
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R>��. .'CERTIFICSTATEMENT-Lit TION .. _ _ .. . "-1<�'�'r ^ `F-""'s`s`"
I(We) !*'t'weaitn.lf�, 'A 'certify that I(w p a my(0Ene -
place of residence or am(are)•.4 'ng e following described real I••- V nder contract for which a Ho ea r ry T u
Deduction is hereby claimed o e date this application is signed, (d W I
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. FEB 5 2016
❑ 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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It buying on contact Fee Simple owner's name
Recorder's oMee where oomnd S receded Record number Page
i 1:Wi .71D.'fl!Td 1 4LORROPERTY,DESCRIP--TION_uw' +• -MICY+-}
CaaeY Township Taxing district(city,town,townahp)
P. number Legal desoipion Is the property in gwsion:
t s , a. , 0 . p - 4 �1-.1 popery ❑ Annually assessed mobie home(1C&1.1-7)
If any portion of the residential ecurure or the land not eacoedig one(1)acre that immediately surrounds tha structure S used to produce income,deseibe the use and portion
at the property pined to produce income.
.. . _ _ .,, r, s -,
- - PROPERTY OWNED ELSEWHERE BY CLAIMANT - - + -�,
Slab,Covey,and Township Is claimant vacating a homestead?.
❑ Yes ❑/, No
I hereby certify the above statements are true,correct,and complete. a, ur,
Address of mead(number and greet.city,state,and ZIP code) I of vacated lmesteed,t arty(number and fine' , ate,and ZIP code)
1 z5-73 F. '02c OAKS .a _ . 4176 60
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ASSESSOR USE ONLY - I .,ASSESSED VALUE r I. 7- HOMESTEAD VALUE _ _I 2 NON-RESIDENTIAL h^
Land not exceeding one(1)acre Immediately t
surrounding residential Improvements O
Other land (2) 7.1 i_'. _ _Li -:
Total land(line I plus line 2) (3) _ - _ _ - I
•Residential Improvements or Dwelling (4) �'>t -_ YS: S•Annually Assessed Mobile I -
Manufactured Home Garage (5) 3.-•,-.:-:-
` K2 c
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (Uric 3 ohs line 7) I(6)
6l
I hereby certify the above Is true,correct, goatee of Assessor Date signed(rm:n,day,year)
and complete.
Verdying action-Signature of Audtan Date signed(•roe day,year)
20 pay 20 I ecs•r of 60%of the assessed value of the homestead or 545,000
Notwit.danding any other provision,the sum of the deductions provided in IC 6-1.112 to a mobile home 5 20 6
that is not a-':sled as real properly or toe manufactured home that is not assessed as real property may FEB 5
not exceed T: alf(irz)of the use - We of the mote home• manufactured•• e.
Signature of s • • I Date si - (tncn.ly day.year)
4�- IIS. AI tit - ° .r
DISTRuBunoN:Original-CowryAuerr,Feesamped Ccpy-Taxpayer GIBSON COUNTY AUDITOR