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Mobile Home_Burns ,nvP aY, 17 -l8 'S-a.a-r? Mr4, , CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR STANDARD I SUPPLEMENTAL DEDUCTION State Form 5471(R15/514) HC70 Presorted by the Depadmem of Local Govemme'd Finance INSTRUCTIONS:See reverse side for filing instructions. NOTE:Telephone,Soda/Seard4,drivers license,state identification and federal idenfGxation numbers are confidential under IC 6-1.1-12-37. • I(We) a certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, __-- (date of signature). I(We): ❑ 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 personal residence trust . ❑ Am (are)the shareholder, partner, or member of the entity that owns the property. :u.s- - f.i ' 1: . s ::: 1v"?. CLAUMNT'SINFoW4ATONF _� . i .a.:- 3,C_:-. . ,1,C4_; Na ' ant(Legal name) UY Name of claimant's spouse(legal name) - Social Seoaiy number of claimant's spouse(last five dks#s) Dm license/Iden3m.ian l Other number luting Sea of claimant's spouse(last fire digt) 'I _ CORD- €�' A.:p__rT4 -;t:— l�'3�.ni•�_:ems..�'iF .ter �"� '�_- aCONTRACTjRECORDED0.� �'S!(y��n 1 _,r. ,.._. .. e If twig on contact Fee Simple owner's name II� MAR 9 2017 Recorders°Mee where contract is recorded Record number Page i�s1 R.rr.`,3.re F- `. .+ATC1-124;i +V'au-&..7.c .ROPERTY,DESCRIPTIONWIS-- e'a lililtla9' a Cor 1 y Township Taxing dsYVi(ciry.town.deostra,) GIBSON COUN ' •UDITOR Parcel number Legal description Is the property in question �� ❑Real property ❑Yeasty asssed mobie home(IC 6-1.1-7) • U of the residential sttcae or the land not exceoLg me(1)acre drat..-ledattely surrounds that sTlfae is used to produce income.describe the 3e and porno., ® Of property N produce income. 07‘.-411-- W i qWa G 0.571.5 PROPERTY OWNED ELSEWHERE BY CLAIMANT ' _ .. , I Sats,County.and Township Is claimant vacating a homestead? . . ❑ Yes ❑ No Signature of claimant I hereby certify the above statements are true,correct,and complete. 0✓C1/fix •..-of-' ,a (number end street city,state,and ZIP cone) .. -.of vacated hontead,if any(number end street cry,sate,and ZIPcode) CO• CU. - ,. . .. chic Pa's e ... _A •T•'U u- ASSESSOR USE ONLY 7-7.-1 ASSESSED VALUE 1 HOMESTEAD VALUE- ' NON-RESIDENTIAL . ,' VALUE Land not exceeding one(1)acre Immediately I surrounding residential improvements (1) Other land I(2) 1 11 Total land(line 1 plus line 2) (3L•11',Y Residential Improvements or Dwelling (4)" LlY ggg Annually Assessed Mobile I - ` Manufactured Home Garage (5) I '-_ `_:±- p5 • . -..}C Other improvements (6) Total improvements(line 4 through line 6) (7) Total value (line 3 pica line 7) I(e) 1 hereby certify the above Is true,correct, I Signature of Foessor Date signed(month,day,year) and complete. Veiyag action-Signature el frocUer Data signed(month,day,year) _ - _ _ , STANDARD'DEDUGTONACCOWANOED 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 ® Notwithstanding 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 property or to a manufactured home that is not assessed as real property may not ex ne-half(1R)of the Lai luue ooff thee mobile homme or manufactured home. I S :evre • - • '� Date signed —/ el �at) DISTRIBUTION:Orignal-Coady Audar.FieSemped Copy-Taxpayer ♦'JJ