Homestead_Sweppy _ - CLAIM TD FOR HOMESTEAD PROPERTY TAX YEAR
"`' STANDARD/SUPPLEMENTAL DEDUCTION FORM
C �. State Fom5473(R15/5-14) HC10
Prescribed by the Depa.:,ea of Local Goverment Faun
INSTRUCTIONS:See reverse side for filing instructions. •
NOTE:Telephone,Social Security,diner's license,state identification and federal identification numbers are confidential u • I( 72 7 ! t ‘
— . _ _ _ >-CERTIFICATION STATEMENT h`,T -n.:..`_ '' ,t.7.(7.1 1 ° _tr } H �'J'-;�sji 1
C ���
I(We) 1..:,.......a.. . L SI • 4r 1.-Mn- - ...✓, certify that I(we)occupi •es my our)pnnapa
place of -j>'- or a (are)buying the following described real property under••.-C for which a Homestead Property Tax Standard
Deduction is hereby chimed on the date this application is signed, (date ofsignj . 24)2016
❑ 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 pe .41 r.•--,r• Td• ?i .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUD TOR
� - .:•
:�"• '"
If buying on=tact Fee Simple owner's ame
Rem-dMS pace where contract tit,ev...edad • Renard number Page
A by`,._ 5 ;7-s's>r y� `inie ki � ORP PER7Y�DESCCRP.TION M4.il°*$F SP-_" f S=L
Couny
Panel number • Legal descripgoo " 2 8.A S A cis the property to question:
/arse S . -/- ❑Real property ❑annually assessed monde home(IC 6-1.1-7)
If any pop on of the residential aTa'uae or the land not exceeSay one(1)acre that immediately sung ds that thrumr:e is used to produce income,describe the use and portion
of the property teased to produce immune.
04 6- oe- o ( - 900 - a 00 . 033 - 0 / 7
,'PROPERTY OWNED ELSEWHERE BY CLAIMANT ; __,
Sate,Carry,and Township Is claimant vacating a homestead? •)
. ❑ Yes ❑ No
y'Sig ature of claimant
I hereby certify the above statements are true,correct,and complete. ( spa
°'ee`dmeted(meterandstreetm'y,stat,endZIPcode) Messofaa lany(number end sties!.al)c Cere end Pmde)4
1 ASSESSOR USE ONLY il, ASSESSED VALUE. I . HOMESTEAD VALUE 1:-. - NONREASIDENTI L.
,
Land not exceeding one(1)acre immediately
surrounding residential Improvements (I)
Other land (2)
Total land(line 1 plus line 2) (3) _ I I _ -_ ..
Residential improvements or Dwelling (4) a._ ' S; a";'y.',11:_-
Annually Assessed Mobile/
Manufactured Home Garage r� --d' i
I(5) m,__ 1 —
__}_.•-
Other improvements (6) I". .. •_ -, ,._ �_-_
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) I(8)
I hereby certify the above is true,correct,
Signature of assessor Dab signed baton;day,year)
and complete.
Vie-Vying adan-Signature ofA dtor Data signed(month,day,year)
��, '=�3e..':r>.v^z nSTANUARD DEDUCTION'ALLOWANCE=>' r-s= a?d' -• ',-. =,ty=9)�,e-a
20 pay 20 • Lesser of 60%of the assessed value of the homestead or$45,000
•
Nolxithsanding any other provision,the sum of the deductions provided in IC 6-7.1-72 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the noble home or manufactured home.
5ek, - .;x. ems) Da
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' DISTRIBUTION: Original-Cm.7adar,Fie-Stamped Copy-Ta>mayer