Homestead_Ulishney <-1Eg4- CLAIM FOR HOMESTEAD TAX
reirms
a q STANDARD I SUPPLEMENTAL DP DUCT N FORM YEAR
State Form 5473(R15/5-14) HC10
Prescribed by the De;atonent of Loral Goverment France
INSTRUCTIONS:See mverse side for filing instrucira -
NOTE Telephone.Social Security,drivels license,sia identification and federal;denti,5tafron numbers are confidential and S• :1- 37. _
- --_...-- " . :.. . `.CERTIFICATION STATE1VIENT `; ' ; 1 1r'o-1) -)I '1 r1 U .;'t7
I(We) //� ice_ ••..
r „ certify that I(we)occupied my ou '• ..�f
place of residence or am(are)buying the following described r-F•perty under contract for which a Homestead Property i Tax Standard
Deduction is hereby claimed on the date this application is sign= ., (date ols49 l•)8V€D 17
❑ Own. ❑ Am(are)buying under recorded contact
❑ 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 •-•r•6' •suft•;f? st .
El Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY r
AUD sR
Recorders cdce where contact C r red - Record number Page
•
'.r'brt_.1, • apE'r 2r=` �x";� �PROVERTY,DESCRIPTION7�` +TS f�rs':gz__s^ _--
Coudy
Township 1 iamg,d(city,foxy lowns4)
Pastel number Legal desaipdm /. /3 3 /I i Is the property in Rrestort\•�///fr-
PT P 17-AJ-t v ❑Real property ❑ Annually assessed noble home(IC 6.1.1-7)
If any portion of the resider:ell exam or the land rot exceeding one(1)acre that i:enecitelj=rounds that gnrSae b used to produce income,des Le the use and portion '
of the property u:T¢ed to produce inctsce.
at&—ia2 • / 7 -toy - DOA . 600 - 0(2 7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,COiaey,and Township Is claimant vacating a homestead?
. ' ❑ Yes ❑ No
re of dainard
I hereby certify the above statements are true,correct,and complete. / • r
.It/A • • Lam.
Address of rontact(number and sheet city,gate,end ZIP code) Amtess of vacated honeaead,a any(number and-•--J.,state.and ZIP code)
tal.... �/.' �.✓.-.. r
' ASSESSOR USE ONLY - ' - I ' ASSESSED VALUE HOMESTEAD VALUE' ' I- ':'NON-RESIDENTIAL-
Land not exceeding one(1)acre Immediately I(1) - S3Y_i?-`
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3) -
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage I(5) I
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) I(6)
I hereby certify the above Is Nue,correct, I Signature of Assessor Data signed(halt%day,yea)
and complete.
Vetting action-Signature of Auditor Date signed(month,day,yea)
61=' :.3C'=--, --� ,__,.. _=ar.;%STANDARD DEDUCTION:ALLOWANCE = S ,
20 pay 20 Lesser of 60%of the assessed vane of the!latrine...ad or$45,000
Netnithvandalg any other pmv von,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $
that is not assessed as real property or to a manufactured home 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 Aullor Data signed(month,day.year)
DISTRtalfil0 And or -L