Homestead_Powers (2) eat CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
!9 N STANDARD/SUPPLEMENTAL DEDUCTION
HC1O
Store Forth 5473(R15/5-14)
Pr:smbed by the Department of Local Goverment Finance
INSTRUCTIONS:See reverse side forting instructions.
NOTE:Telephone,Social Security,drivers license,state dermal -tion and federal identwation numbers am confidential untl -. 1
fr .• .. .."'-' �.' 10ERTIFICATION STATEMENT �. .. - -- c -' ,)
I(We) • 4�. l i��.•IL . ` l certify that l(we) . -.a `oar pnnapal
place of residence or (are)buying the following described real property under contract for which a Homestead Proo rbeTax Standard
Deduction is hereby claimed on the date this applration is signed, (date of sign l&O 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 perso I, - 743;7.;i .
El Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AU ITOR '
—_'
.
If brytp on contact Fee Simple owners name
'Recorders o5ce where mtad is recorded I Record number I Page
jai — +t—1:2_F_,7: PROPERTY,0ESCRIP.TION : -1 _' 2Y-Zrt-ttr ec_ }
Corry Towns-fp Tax ng dsricd(city,loan,tow:sly)
- --
Parcel number Legal description m
io: Is e property in gu t
❑Real progeny ❑Annusay assessed motee home(IC 64.1-7)
d any pence of the residertal stutse or the land not exceeds";one(1)acre that i.:edacly surrounds that structure is used to produce income,decree the use and poem 1
of the properly r flied to ponce bore.
a (0—' -2 - Liao - 00Q. 3'13-oas'
. • - •• , ' : PROPERTY OWNED ELSEWHERE BY CLAIMANT . l
Sate,Casty,and To mshlp Is claimant vacating a homestead?
❑ Yes ❑ No
Signet, of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contxl(numberend greet arty.gate,and ZIP- of vacated homestead.I any a any(n�Meet oly,date,end ZIP cede)
- • • s • e l ( 70
•
ASSESSOR USE ONLY I - ASSESSED VALUE ; .HOMESTEAD VALUE. _. NON VESISIUENllAL
Land not exceeding one(1)acre Immediately
surrounding (1) _
surrounding residential improvements
Other land (2) '�• ..•��M
Total land(line 1 plus line 2) I(3) _ . _ __ _ -
Residential Improvements or Dwelling I(4) I `-.-'
Annually Assessed Mobile I - --
v
Manufactured Home Garage I(5) I
}K
Other Improvements 1(6) I,..,:-'..'- 't _ __ L"
Total Improvement(line 4 through line 6) I(7) I
Total value (line 3phs line 7) I(8) I
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(nmttl day,year)
and complete. �1
Veri'ying cedar-Sie naa of PUSar Dates ( �a)E D
� y-4STANDARO DEDUCTION�ALL'OWANCE �`• �l"
20 pay 20 Lesser of 60%of the a%wssed v&ue of the homestead or 545.000 DEC 2 9 2016
Notwithstanding any other provision,the sum of the deduc ions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a m ufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed vat of the mobile home or manufactured home.
Signature �g�p Signature of PUdmr few Dra lit 0 1N
l TY A.IDITOR
DISTRIBLmON: Original-County Aod'sr.F e-Samped Copy-Tagayer