Homestead_Horn r CLAIM FOR HOMESTEAD E TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
HCI
O
State Form 5473(RI5/5-14)
Prescribed by the Depamnem of Local Government Finance
INSTRUCTIONS:See .erse side for filing instn clkins.
NOTE:Telephone, • Security,drivers license,eta,.•en6ication and federal identification numbers are confidential under IC 6-1.1-12-37.
I(We) S/ ' ��Str%L A. certify that I(we)occupied as my(our)principal
place of resi•- ce or am(are)buying 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 ocarpy 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 tuyig an contract,Fee Simple owner's name
Rewrdefs o5ta where contract is recorded Record number Page
LF.}� .. • `s__ -f_a.' �d�1•'e Yt P,ROPERTVrDESCilrrli NT ?z=- tit-X--1 aeX;Fi el
Cam' / • Township form,torvnshb)
�, IT Or
P. --noiber Le/p�'Q�eaoipim n Isee pe yinq on:
nit C / '/_\'rte/ \/{/r(�'Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any Or the rea/dettial=tire IX the/dt`rldl one(1)sae I t�ledNxly Mint"'
=Litre b used to pvduce income.describe the use and portion
of ny to chat tare.
oZo? - 06/07.3.3-0-?2 o2- op 06/07.3.3-0-?2- PROPERTY OWNED ELSEWHERE BY CLAIMANT - - -
ars.Casey,and Tawnshm Is claimant vacating a homestead?
. - ❑ Yes ❑ No
Signature• d•trtara
I hereby certify the above statements are tine.correct,and complete.
'7/� Address of rmad(number and soset,city Sate,and ZIP code) of vacated homestead,if any(number end street,cdy,Sate,and ZIP code)
1 ' _- 0 _ 1
�: �y I. :.n 1 /
ASSESSOR USE ONLY I. ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) L _ rvti.r r
surrounding residential Improvements --. _ - — -
Otherland (2) .—.=- ^e. ._..w.r. _
Total land(fine 1 plus line 2) (3) - - -
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ 1 t ® - ,
Manufactured Home Garage I(5) ,.. . .r1_ r w
Other Improvements I(6) :.''.� "-!' ..-,nr--k1 1 2n is
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) I(e) 1 -_ d ai I
Signature ofessaeser rx NT? A ninth,day,yea4
and complete. the above Is true,correct, GIBSON CO 'NTY AUDITOR
Ve1'yag anion-Signature of AuCtor Date signed(flora day,year)
'<= ' yy7, 411R` +`f'y' .STANDARDDEUUCTION•ALLOWANCEr - a
20 pay 20 Leswr of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured hone that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Aad:or Data signed(matt'day,year)
DISTRIBUTION: Origthal-Courey Audtor,FleStamped Copy-Taxpayer