HomeMy WebLinkAboutHomestead_Wilson (17) , . CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
t/11/ STANDARD/SUPPLEMENTAL DEDUCTION
4.-.:-.'e.:4'� Slam Form 5473(R17/1-16) HC10
7 Prescribed by the Department of Loud Government Finance
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INSTRUCTIONS:See reverse side for Ong h,stucbms.
NOTE:Telephone,Sodal Secwdx driver's license,state iderr65rab'on and federalidea:Bca5m numbers are confidential under IC ill 1 ,7.% (
' CERTIFICATION STATEMENT ,)
I Mk) 1IW Z nine reltdy that I(we)occupied as my(art)principal
place., —.. ••or am(are)buying the following.__ate_d real property under contract for witch a Homestead Pi Tax
Deduction is hereby claimed on the date this application is signed, (date of slgnatu/ta Lli U I
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am(are) entitled to ccolpy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified personO.resirlencettaGit.
❑ Ann(are)the shareholder, partner,or member of the entity that owns the property. GIBSON COUNTY Al DITOR
Toemhp Taxing doid(ray.town mersI*)
Pawl motet lapel desava Is cue papery at question
❑Reel pngary ❑Annually assessed noble hoe(IC 61.1-7)
If any port on dm iaspatal stpm+e a the lad not ensectng one(1)acre as inmeductelysumanch that smxnae is toed to prcdxe income,describe the tee aid screen
of the property robmed to produce imtn
9 - G. 01- 103 7000. Sea --Oa&
'T .r ' '-i+ ,- rPROPERTY,OVJNED ELSELYfiFJ2E.BY,CL�AIntaNruk -Y-'.° .,t ."' ;=" ` t`
Rata,Couay,and TOAtdep Is claimant vacating a homestead?
❑ Yes ❑ No
ddaunart //[/
I hereby certify the above statements are fine,correct and complete. ��J
. . mead eaY-•�. cub.-.... ;ZIPCp�) Addend if any(number an meet sal:stab.and ZIP code)
-_ - ,ASiESSOR US—ONLY ASSESSED VALUE,'"_� �MOM ESTEAD JALUEl _ ''� NON-RESIDENTIAL -
Land exceeding ore(1)acre immediately
surrounding residential improvements (1)
Other land 3 ,c
Total land(line I plus fine 2) (3)
Residential improvements or Dinging (4) y Nom_rl t-
annually assessed mobile l -
manufactured hone Garage (5)
Other improvements (6) y .s - :i{7�: *•
Total improvements(line 4 through lime 6) (7)
Total value (line 3 plus fine 7) (8)
1 hereby certify the above is true,correct, Siam or Assessor Date signed(mrtq tax yea)
and complete.
vent/zoo ammo-Setaare of WOO/ Dm signed(mmik day,year)
la b kagr YNitte:---- STANDARD DEDUCTION ALLOWANCE e-?wxisylystL•rkg.. -•+very"-. ja�'.'±.�ie.-V,,`7"
20 pay 20 Lesser of 8096 of the assessed value of the homestead or$45,000.
Nofeehslanceng any oterprovison,the sun of the deductions provided in IC 6-1.1-12 b e Meade home S •
that is not assessed es real properly or to a manufactured home that Is not assessed as real property may
wafted (l/ZZ of the assessed of the nttxb home or manufactured hems.
3gaeedA� To 31- I ii
.Original-Caaay Audis.Faesmnwd Copy-Taxpayer
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