Homestead_Kirk .." CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r -mil L STANDARD/SUPPLEMENTAL DEDUCTION NM
� y Sbta Form 5473(671/1-16) r -
P_fJ Resented A me DepaNVa Cr ta81 Owa.vomY Foram
INSTRUCTIONS:See reverse side for any moons - - r
NOTE Telephone.Sodal Seaat c&Ne s Bcense,stare fdar65ca5an and federal(den hcedon numbers are••.'...-n'.• ,.. ' : . 1 .
� �CERTIFICATION STATEMENT �p j
I(We) S,-1,feII!e\./`_:y certify that I(we)04l'L. -_4.or;prindgal
place of residence m- /are• •the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby•_, -•on the date this application is signed, (d signed+ ). I e-
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporatioGIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the trust cc the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are)the shareholder, partner,or member of the entity that owns the property.
��ffaay■■�
Pm matter /�y�(�. Lagsc aytm ono. -.. iiPdsiart
A / II-1 a-I s/r—o'I/. • ! M I. Red ROpay ❑Maus%assessed mot es brae(IC 6.1.1-I)
If any porda'of to resoers)dmu,cn or the land not eceeanp one(II etre that mmammey-. • •. .:.Mauro u used to posh®Income desmte ore use and portion
d the property oared to dolts from.
Er.o.r,. Yrc' + - :fr -.:P,ROP ERTY,OYJNED,ELSELVHEREBYCLAI6iA tap••. — -tt -p'.at {-.,<<i{p. ))
Ste.Ca^'y,ad Reed* Is daimad vacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. ' •,Ail AlligSaiiiiiiiiiiiiiiiii
ASSESSOR USE ONLY- -. xa--- ASSESSEDVALUE's r HOMESTEAD\ALUE 1. - NOU-REALUENTIAL.. •<�
F7elirigil.(1) a -C- ,--r
__
' ,
5Other land (2) t,f;cu =°_ 4id
Total land(line 1 plus line 2) (3)
Residential Improvements Irrmprovemumb w OvreIDng (4) z z : ,y c iM1 -
annually assessed mobile I -
manufactured home Garage (5) -cf t ..2 : s _
Other improvements (6) ..•fi "- s sir '.:3`
Total Improvements(line 4 through line 6) (7)
Total value (gum 3 plus fine?) (B)
I hereby certify the above is true,correct,
Sp at'55 of Assessor Date signed(nn'tk tax yeas)
and complete.
Vatyiug salon-Sirytttae al Auditor Dim sired(n.'a day,year)
a'_. Ctiv ?. 3 -: y. , ,,, -;`rSTANDARD OEOUC?I AALLOIYANCE sip _ v��j 71r-s-,'.
20 pay 20 Lesser of 60%of the assessed vSue of the homestead or$45,000.
any omerprovsion.the sum Of the deductions pmMded in IC 6-1.1-12 to a mobile home $
marls -- as real property or b.manufactured home limns not assessed as seal property may
mtn- :. .-:•-a/(t/n o/Iheassessed .true oftfre .wmanrdazoaed home.
DISTRIBUTION:Original-CanyM6a,ne-SomPed Copy-Tye I
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