Homestead_Horn R _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-"^ STANDARD/SUPPLEMENTAL DEDUCTION FO•M
stye Form 5471(Rf5/Std) �.D f i
Prescribed by he Depanmer vt Loml Gomtumer Finns '�. ',:
INSTRUCTIONS:See reverse side for filing instructions. •
NOTE:Telephone,Sod.b-. ets 1 -nse,state identification and federal identification numbers ere confidential under IC• - 2- 7.a e•,157;_.1.r•• -, _il IT'JL.'r 'w,'CERTIFICARONSTATEMENTYaw J•, 7 r7,--t Oe tr tlIsm:,
I(We) ft./ •I certify that I(we)occupied as my(our)prin ' I
place of res•ence or am(are)buying the following described real property under contract for which a Homestead
Deduction is hereby claimed on the date this application is signed, (date of s/
El 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.
it baybg on contact,Fee Simple owner's name
Reader's office where contact is s'�r,r Record number Sage
0t-/a-05--"/ c". .20.1.-la- 4027 ,0.a4. .'.tdadd Di
Mien rs t WTownship
_ E PROPERTY:DESCRIPTIONaE;`"-S.':'!aT. ;:F =y+{y>-Ts"
�'areel neither^ I',.� ,��- desoiceon Is the property in poesthn:
(0-la-� h'17 ) ❑Real property ❑Annually assessed mobile home(IC 6-1.1-n
tl any portion of the n er al�s re x the land ino• exceeding we(I)acre that Im.:ndxsh earceatrs that stnrAae is used to produce income.de Le the use and portico
tithe property rtJaed to produce income.
iN1oVpd in brnn i _sea. add Ole- C� SUJLO t
___ PROPERTY OWNED ELSEWHERE BY CLAIMANT
Rau.Cony.and Toa'mkp Is claimant vacating a homestead?-
. - ❑ Yes ❑ No
yuNre,
I hereby certify the above statements are true,correct,correct,and complete. S
///
Address d ct(manner end street rdy,stee,and ZIPc de) Address of vacated Mnes.e number and reel.tit):state,end LP code)
a _ Ca erg/• Ot/ //.•
ASSESSOR USE ONLY - 'I1- ASSESSED VALUE l ' `HOMESTEAD VALUE:9 'NONRESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately
r
surrounding residential Improvements (1) �a
Other land (2) Iii A tee_ _ _
Total land(line 1 plus line 2) (3) -
Residential Improvements or Dwelling (4) ••"'." `�' _ a
Annually Assessed Mobile/
Manufactured Home Garage (5) a_ •1 Y-7^,1
Other improvements (6) `'i �
- .°
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus fine 7) (8) '1
I hereby certify the above is true,correct, Signature of Assessor
and complete.
Verifying action-SSnatre ofAudtx Date signed(moth,day.year)
FEB 18 2016
CIS '' MMLEM' y�'h/STANDARDDEDUCTIONnALLOWANCE _. ///111 .2
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nofidlsland a any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home GIBSON COUNTY AUDITOR
that is not a -Sr_ as real property orrro a manufactured home that is not assessed as real property may
not exceed o aff(12)of�he- I•value of the mobile home or menufadored home.
Spnave ofd 'Oats signed(. dart year)
Name l •,4 c� �6
DISTRIBiR10N:OrigiW-COwryPUddpn Fie-stamped Copy- v.
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