Homestead_Hale (7) 4:14111+, . CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
- STANDARD/SUPPLEMENTAL DEDUCTION
Stab Form 5473(R15/5-14) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions ( !
NOTE:Telephone,Social Security,drivel's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-7.
1 -, - ' •:CERTIFICATION STATEMENT'i„je r'''_:`S L`•c'Y°_-; c"'pry '4'.".2
O�:1�1____ �725� rarkr i!�
4”. c .016
I(we) r.• . • •• ••`I(we)occupied as my(. n...
place of residence or a (a - buying e following described real pro.- .•j nder contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signatureGIBBON). I ): .
oval. ❑ Am(are)buying under recorded contact.
COUNTY AUDITOR
0 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.
.'.
U buying on contract Fee Simple owner's name
Recordees o5ce where contract is recorded • Record number Page
gli"• t 'A _;pi PROPERTY DESCRIRTIONS;= h--.4es _"° el
County Township Taxing distrid ferry,lath township)
Parr l mother Legal desoiphon 1 Is the properly in 9 son: _J
QIL.'1 `"- -.OLbO -.L't)5 _ eaL V(C ''V \ ` eel property ❑AnnaIy assessed cootie hone(/C6-1.1-7
if any paton of the rnWKia1 stnithare a the Lard not exceed-Ty one(1)acre that inrredaby surrounds that=care is used to produce income,describe the use and portion
of the property canted to produce income.
�
� - ///3_ i//
r...._. U a ' PROPERTY OWNED_ELSEWHERE BY CLAIMANTI _ [,•:. • ..•''
Sate,County,end Township Is claimant vacating a homestead?
. ' ❑ Yes ❑ No 29.Signatire of I hereby certify the above statements are true,correct,and complete. (+ )244, / Q /�
Address of contact(member and street,ray.slate,and ZIP code) II Address of vacated ficenes( d any(number end street ceyt sate.and ZIP code)
IS$O 5 OrD ST r.c °I, 6)5 tr: ce+on , IN '/7&70•. ASSESSOR USE ONLY r L ;'ASSESSED VALUE_ 171:s-HOMESTEAD VALUE kJ I :NON-RESIDENTIAL.
VALUE
Land not exceeding one(1)acre Immediately (1)
- 'v e.-4- 2
n
suoundingresidentialImprovements
}
Other land (2)
Total land(line 1 plus line 2) (3) I _ ___. _
-
Residential Improvement or Dwelling (4) • 4 v
c
Annually Assessed Mobile) - .r �.., - .•+q
Manufactured Home Garage (5)
Other improvements (6) ;,-r ?'J J
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (5)
I hereby certify the above is true,correct. Signature of Assessor Date signed(month day,year)
and complete.
Veiyig action-Signaatre cfALdtor Date signed(month,day.year)
K •s,•,�3 -,tf_ -, 3--,.gF=' STANDARD TEDUCTIONrALLOWANCE 4-
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000 T $Ip��',Il ',�
NohviNs:anderg any other provision,the sum of the deductions provided in/C E/.1-12 to a mobile home S F $L El I
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1R)of the assessed value of the mobile home ormanufactured home.
Siprta'vm of Auditor
` C
Data signed(r _
4 [U'6
�t�fl� ) 4- "
DISTR9UTION:Original-CowvyAWi:a Fae-Sa mped Copy-Taxpayer
GIBSON COUNTY AUDITOR