Homestead_Garwood f CLAIM FOR HOMESTEAD PROPERTY TAX : a
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4.. �;: STANDARD/SUPPLEMENTAL DEDUCTION FORM . MI
' q; Sae Form 5473(R1711-16) HC10
Proscribed by meD cal tam Government Frame JAN 1 9 2018
INSTRUCTIONS:See reverse side tarfifmg inWr8ons.
NOTE:Telephone.Social Senat(I(dives acme,state idens5raron and federalltrrdernefdn mmleers are mrl60emtal° Ut'! C +: • b.
A ION
CERTIFICATION STATEMENT - '
I(We) '101! 1L`♦ ���, J.l/re �•�./'J gym'•/ •L'rd&y<u-ql.ansfer
Certify that I(we)occu
plane of residence or am(are)buying the following descnbed real property under contract for which a Hof ,.,. r'c cis n r AUDITOR
Deduction is hereby claimed an the date this application is signed, (date of signature). I(We):
�`❑ Own. ❑ Am(are)bIMng under recorded cnhatl
❑ Am(are) entitled to occupy as a tenant-stockholder of a son Auditor
( ) cooperative y under the tenntton. Gibson Count
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a Bersartal residence trust
y
❑ Am(are)the shareholder,partner,or member of the entity that owns the property.
\
County Towel Tang fseid(ay.foam Nalshp) - /
/I)A A• / a •
' Pan naee toge denote Its amen in question
❑ • -1 assessed vobee hie(IC 61.1-7)
If arty cotton of the rendered stnmdsre or ea land not exceeding me(1)acre net immediately strands that euchreLs used to produce tom one,sesate the use at pation
of the property uteted to produce imam. -
(OI -oG-07 _/06 (793,07 l ? 0) 7
'- -r-r, -o 5 std PROPERTY ON7NEEI ELSEWHERE:BYYCLA MIA tit ',)&e `"_ °° r.=-'fr .
eaa.Canty,at Tomslup Is claimant vacating a homestead?
❑ Yes • No
mdm
claimant
I hereby certify the above statements are true,correct,and complete. )) An/-'f ,
Address of cones(naderend sheet cr',,ante.ed BP an) i Adders of vasd tvaestrad., Muster and street cN:sh'e.arc,an code)
SLcS- ,504) I
_� - ._ NOA-RESIDENTIAL,.: _
)..-,r ASSESSOR USE ONLY _ 'I ASSESSED VALUE_ HOMESTEAD VALUE_}I --ygLUE
Land net exceeding one(1)acre immediately
surrolladimg residential imprmvemmb (1) _......-.f s.._3-ffi;f<ItINliF
Otter land (2) i`' - ...
Total land(line 1 plus fine 2) (3)
--s s iResidential improvements or Dwelling (4) -_ x .
annually assessed mobile I -+ - 'r�.3 s
manufactured home Garage (6)
Omer improvements (6) •.n';=K .`:,�1:-.=- rx.='
Total improvements(line 4 through fine 6) (7)
Total value(fine 3 pia line 7) (a)
1 hereby certify the above is true,correct
Signature of Assessor pap sum(°°`try rep,yea)
and complete.
Verifying ernm-Simuam mAUG1a
-TV4 n,-St- ''---. .r , ,_ r J. :STTNOQ RD DEOUC31ON ALLOWANCE-?-w :- _ __ .' •7yi ....,.2
20 pay 20 Lesser of 1:096 of the assessedvdue of the homestead or$45.000. JAN 1 9 2018
NohnMsfarufug any other provision,tee sum of the deductions provided in IC 5-1.1-12 to a m=ile horse $ •
that is not assessed as real properly or to a manufactured hone mat Is not assessed as real property may �/
not mimed one-half(12)of the assessed value of lb.mobile home or manufactured home.
GIBS 011 C�m4 mtOR
DtSTWaUTioN:Original CmaayAUdaar.Re-Sapped Copy-Taxpayer
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