Homestead_Curtice •
r. _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t ''- STANDARD/SUPPLEMENTAL DEDUCTION FORM -
-_ State Fonn 5473(R15/5-14) H010
Prescribed by the Depaf nerd of Loral Government Finance
INSTRUCT IONS:See reverse side for Mug insbudions. •
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
s a,.
I(We) certify that I(we)occupied as my(our)principal
place of residence or am(are) uying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ 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 personal residence trust -
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contact Fee Simple owner's name -i
Recorders o5ce where contract is recorded Record number Page
+� -�-�•TFh E'_�-_:'_��=F'�_.�v.'k':._..,.��PROPERTYtDESCRIPTION=�':�'sf>e.. _� .-'w".r.s.r 3.�i�:�-�.aF..�...r_A,
Caccy Township Taring district(city,fawn,tamshp)
Parcel number dLegal deteitlon 4 I T Is the property N question:
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IT T se /-.3-/2 9 A-G ❑Real aopeny ❑Annually assessed mottle home(IC 61.1-7)
If any portion of the residential structure or the land not exceedng one(1)ace that immediately surrounds that stn#tae is used to produce income.describe the use and portion
of the property Loused to produce income.
oZ(o - 17- co / 903 - 000 . l9G - o .L�
•PROPERTY OWNED ELSEWHERE BY CLAIMANT _
•
State.County.and Towns*. Is claimant vacating a homestead?
❑ Yes ❑ No
of daimam aimans
I hereby certify the above statements are true,correct,and complete.
/Address of correct(number end Street,ay,&ate,and ZIP code) Address of vacated homestead.E any(number and street rd y,Sate,and ZIP code)
I(\ ._ 08 , wens■fli si7b6S
ASSESSOR USE ONLY I ASSESSED VALUE' I • HOMESTEAD VALUE ,'I NON-FTSISIDENTIAL •
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Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements a--
Other land (2)
Total land(fine I plus line 2) (3)
Residential Improvements or Dwelling (4) 11i _ _.11 11.6 •� ht.
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plea line 7) 1(8)
I hereby certify the above Is true,correct,
I Signature of Assesses Date signed(rmnth,day.year)
and complete.
Vedyi g advn-sigrahne of Aerator Date signed(monM,day,year)
t�e^L- -e .L—st. "s ;?:tj•=STANDARD_DEDUOTIONALI.OWANCETgLV_t .04:o/tragl _".*.r,-
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45,000 1.11
Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may JUL 2 0 2016
not exceed one-half(la)of tthe
assessed value of the mobile home or manufactured home.Aadlor Signature' Cite signed(tnetN day.yew)
ex ,2 -- /,e o _ �+ "`vic
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DISTReulloN:Original-County Aultor,Re-Camped cop)-Tareayer GIBSON COUNTY AUDITOR
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