Homestead_Williams ,4<ficit-,. - CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD I SUPPLEMENTAL DEDUCTION NTAL DEDUCT FORM YEAR
State Form 5473(R15/5-14) HC10
Prescribed by the Department of Local Govern nenl Finance
INSTRUCTIONS:See reverse sire for filing instructions. •
NOTE:Telephone,Social Security.diners license,state identification and federal identi caLion numbers are confidential under IC 6.1.1-I r 1 T•v• _ t -'S.'CERTIFICAT)ON STATEMENT l' u- ;vs�.,9 rid+�)-•1,(.r�i'i
e) .. . . ��I� r
I(We)� �� x�b .x L// / } ,certify that I(we)occupied as my(our)principal .
place of residence or am(are)buying the following described real property under contract for which a Homestead Property T er,Q
Deduction is hereby claimed on the date this application is signed, (date of signature). 3 . 01
s bw'n. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. • a
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal r e- . m',�rMrie.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDITOR
--_; _ _
II'eying on c react Fee Simple axis name
Recorder's o3ce where contract is recorded Record number Page
e¢'' -_: 'v, 21.4&.t'-77A2V1.-M9LIWEIRERTY,DESCRiP.T10N'.>y 3 1!x.-.� 'p' a4 --..'�°`.•""12
County Township Taring district(dry, can,I nos�'')
Parcel number Legal desoipt , I`the,., Toesboc
/Real
property y Avruasy assessed mobile home(IC 6-1.1-i)
C arty portion of the residential endue or the land not exceedsg one(1)acre that ktr eda:y surrounds that stuf sere is used to produce irsorne.describe the use and portion
of the property u'2'ced to produce income.
Co —05-O/ - 316c 00 3 loii 6 o / 7
W CLAIMANT` PROPERTY OWNED ELSEWHERE BY CLAIMANT '•' : - �.
i
Sate,Coy,and T _ - _
Township Is claimant vacating a homestead?
. ' ❑ Yes ❑ No
S7.tire of ��e `�
I hereby certify the above statements are true,correct,and complete. v//A°/_-`
CLriy/LLC.
Aid.-� .-.tact(number and sleet aSt Sala,and?P rode) Address of vacated.'mesead,d any(number end street,ay,sowe,and ZIP role)
3i_ z,
A :.� Sat , 6(IldC 7'ifd
.ASSESSOR USE ONLY I ASSESSED VALUE--- I' ',HOMESTEAD VALUE,. l-
I NON-RESISIDENTIAL ''!•
Land not exceeding one(1)acre Immedlately (1) +4 Y .:
surrounding residential Improvements -- --
y�__y r.-•_�i1r
Other land (2) . .-
Total land(line 1 plus line 2) (3) IY — _ gg_
Residential improvements or Dwelling (4)
Annually Assessed Mobile! • rye` j
Manufactured Home Garage (5)
Other improvements le) -r T' ` -t
Total improvements(line 4 through line 6) (7) I4
Total value (line 3 phs line 7) (8) I
I hereby certify the above Is true,correct,
of Assessor Date signed(m nt' day,year)
and complete.
1 Veiying action-Signature dAUdSr Data signed lire.day.Mar)
E_i a,... ` 2rSTANDARD DEDUGTION'ALLOWANCE
20/7 pay 20 Or Lesser of 60%of the assessed value of the homestead or 545,000
4.c►
NohsYhs`andl g any otherpro'Asion,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home ormanufacured home.
Sig- p or Data signed( year)
'LA. _5---)2.7,71, /-/ ]
DISTRIBUTION:Original-Coady Aodta,Fle-Sapped Copy-Taxpayer