Homestead_Riley (9)I;
CLAIM FOR HOMESTEAD PROPERTY TAX ni
w STANDARD/SUPPLEMENTAL DEDUCTION FORM�r''� 4 )
<9
State Form
by 5473 the(R15/S1a) HC10 R l �1.��!��
Prescribed by the Depa.:mem of Local GOVemmemF�m BBl"� PL/
INSTRUCTIONS:See reverse side for fifi g instructions. -
NOTE:Telephone,Social Severity,driver's license,state identttation and federal identGpaton numbers am conffidenfial under IC 6-1.1-12 s
_ -- .CERTIFlCATIONSTATE67E14T T'' . -.v- C' -_.',VII'.i'•!L$r,?'-'
I(We) i G llinall 1! I• certify that I(we)occupied as my our)princi••n l
place of r . nce or am(are)buying the following described real property unde A: tract for which a Homestead Pro _G/ r VI
Dedu • is hereby claimed on the date this application is signed,
(date of signature. '•?(_ •11(a
own. ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. GIBSON 0 NTY •UDITOR
❑ 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.
If buying on cadad,Fee Simple owners name
1 Recotdets cSz where contract S recorded • Record number 1 Page
. �:• s �PROPERTYDESCRIP,TIONrb��� ^ ira-tvi
County
Taxing d ric(city,town,township)
aaratter �/(]C /•'(�/�■w�Legal deseripion •/�/ R Is the property in queslac
_(/✓- •J'--•_ •sip -OD 1. / V�-Oa') ❑Real property El Annually assessed mobile home(/C 6-1.1-7) •
If any portion of the residential sb' Ise or the land not evzedbg one(1)acre that irrenedv' y surrounds that sauCae is used to produce income,describe the use and pardon .
of
the property wed to produce incx:e.
- 'PROPERTY OWNED ELSEWHERE BY_CLFIMANT _ -- _i .
Sr_,carry.and Township Is claimant vacating a homestead?
❑ Yes No
5i{{{{����aa'��r�'is bard /nr
I hereby certify the above statements are true,correct,and complete. / •
4 A
Address af u u c'mbv and sbaet,oy;a( and ZIP mgais L4% • o vara'sd Barry(number city stem,end ZIP code)
ASSESSOR USE S ONLY: , ASSESSED VALUE :'HOMESTEAD VALUE , I, 'NON-RESIDENTIAL ,'- -•
VALUE
Land not exceeding one(Nacre Immediately (1)
surrounding residential improvements
Other land (2)
Total land(fine 1 plus line 2) (3) _ - _ _ ._
Residential improvements or Dwelling (4) I 'atr}}t:;', "_ -t-y =ya
Annually Assessed Mobile l `
Manufactured Home Garage (5) I .-..*-T- f'„I 4�;- T
J
'r
Other Improvements (6) --TY— .-_2_. . _s.:a
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Aasesso Date signed(nom,day,year)
and complete.
Verifying action-Signature of Audtor Date signed(=rat day,year)
_'y --a _ -..”"a'STAN DA RD DEDUCTION'ALLOWANCE:"—'°"•'+'�_g; ys" "z^:=-
I
20 pay 20 Laawr of 60%of the assessed vsue of he homestead or$45,000 .•
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile he• I
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-hat(12 /the assessed value of the bile home or manufactuurreedd home. 1�n•
Sgravre mAUti:w _ 11` 1_ r V \ HI aY qrj�da
DISTRIBUTION:Orgial- d Copy•Targayer 'w7J-/,rf v (I/s/, I. ' i/iin1/.
GIBSON COUNTY AUDITOR