HomeMy WebLinkAboutHomestead_Earles t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
`' STANDARD/SUPPLEMENTAL DEDUCTION FORM
Stab Form 5473(R15I5-14) HCT O
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for firing instructions
- NOTE:Telephone,Social Security,drivels license,state identification and federal idenYxetion numbers are con5den =aim .1-1 -, Ia.
• --.)-•.-,.-- _ - 1•7 ,CERTT1F1C%IPOONNSTATEMENT!il . `I CI i�'" ..r'. .--,t•_If-S4 { .
I N✓e)_ • ,i���3��'�l-`�7 Cl.4' certify that) -)..::r.-. . „ ..r •pal ,
place of Fesioence or am(are)buying e following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (datrkkAintu0).2 ):
❑ O.vn. ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
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El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualrt ce trust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDITOR
_ _� — _
.
If bNgg on contact Fee Simple owner's
name
Recotdefs oCce where contract is recorded • Record number I Page
iuTrfr cT 11a' -rs 71 uff tTi"i_`tfl:I",;ore`vxTa'PROPERTY;DESCRIP-TION'f-40S ;s - rKra"-.,t``
Lamy Township Taseg dstici(city,town.towns*)
Parcel number legal desmpico Is the property in question
❑Real property ❑Annually assessed noble home(1C 61.1-7)
If any cabal of the residential nn r..-re or the land not exmedxg one(1)acre that immefa.Ny=gourds that s'waae is used to p educe borne,descice he use and potion
of the,.r,,.,y tet ed to produce income.
&(0 ' 12—) b -dap - DOI' 790 -Ca '7
Sate County,and Townshsy Is claimant vacating a homestead?
❑ Yes ❑ No
Sig pave of d/aimam _
I hereby certify the above statements are true,correct,and complete. , 'v'�[K�f(�,N�Wf//)/� C
.- -
of mtt (number end sr,w state,end ZIP•. of v5rax homestead,d any hunter and street.roc%.stab,and LP code)
3 •ip
• ,A, ..14•4 16'
ASSESSOR USE ONLY IT ASSESSED VALUE • I HOMESTEAD VALUE -ufON-REDENTIAL-i 1 '
• VASILUE s .
Land not exceeding one(1)acre Immediately
surrounding residential Improvements (1)
Other land (2)
Total land(line 1 plus line 2) , (3) . .
Residential Improvements or Dwelling (2) 51-_ tl _.i
Annually Assessed Mobile I _ -,,
Manufactured Home °
Garage (5) . _. _ .- _ _ � .•
Other improvements (6)
Total improvements(line 4 through line 6) 1(7)
Total value (line 3 pies line 7) I(6)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed Irma*day,year)
and complete.
Vaiyiig action•Signature of Audtor Date signed(month.day,year) '
, :M Mt ' " TANDARDDEDUCTIONALLOWANCE '- - - .--;..--7".. ' _::4y- t...
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 .�
Abtwiths andiig any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real properly or fo a manufactured home that is not assessed as real properly may
not exceed on as(12)of the assessed v of the mobile home or manufactured home.
Spra^se of Pudt Dab ' (nmtly daY.
R3
DISTRIBUTI N: rignal County Aud:.or,FleSamped Copy-Taxpayer