Mobile Home_Corn -,'"''t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a.- -sal STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fonn 5473(R15I 5-14) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions •
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under lC 6- - 3 I I
`-s- v�.,-- - /f ' .-. " - CERTIFICATION STATEMENT•'.._. <, ire;.F.594, ,}I.?;F: `'•) '
• I(We) 0/ L ` certtry that I(we)occupied- my a•-
'
place of residence or am(are)buying the following described real property under contract for which a Homestead Properly Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature).NG' 1 0 2116
r 1�• ❑ Am(are)buying under recorded contract
(are)entitled to occupy as a tenant-stockholder of a cooperate housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal r-1rl,r -41 yi
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY •UDITOR
- ::_--...n°_• . t_. bc1CLAMAN$SINfORMATO _ :'.i ._._ l -:7-.__•__. ��r?M
Name of (legal name) TelepMnenun of r
VolL d� ` _ .r0
O
Social Sealy number of claimants spouse(rest Me des) Driver's license/ldent5atron/Oiler number lash g sate
of claimant s spouse Vast five d�)
_ sTs+ i i_. 5-4a. tom..._:5' S4 CONTRACT,RECORDEDYF-f 1�•S•_L: [.T. .V/Z-.
y-�5f' -e-
If buying an contact,Fee Simpb owners name
Recorders o5a where cnaad is recorded • Record numter Page
Caqr?'y, =r 11fn-itir. %'_d 1 "PROPERTY;DESCIPON' ?M4 `s_'fit =i--- =
Township 1 Taxly dstrid(i /n lams*)
Para)number Legal deaoii'ptpon r'f-a ,.Ais t}hee+lpproppeerly in pcs]ac
/9 O l e s-c1/ea.¢s��p r y L aM assessed noble home(IC 5-1.1-i)
If any portion of the residential stature a the land not exceed:hg one(1)acre that immediately surrounds that suudiae is used to produce income,describe the use and portion
S M pmpey
Qr Sr��rmcre.
A6p/7 a6 - - -v im-cO
PROPERTY OWNED ELSEWHERE BY CLAIMANT _
Siam,Casty,and Township Is claimant vacia_ng a homestead?
. ' ❑ Yes ❑ No
Skpa:ue d
I hereby certify the above statements are true,correct,and complete.
I U � , ,_.
ApG .wnlad(number end 5reet.nay;sate,and ZIP code) l 7,44 Address of vacated homestead,if (number and street ,ter,and ZIP code)
/3 es . E a S O„R nvoc e' iN
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RE EN
SIDTIAL L
.
VALUE'
Land not exceeding one(1)acre Immedlately
surrounding residential Improvements I(11 _ �'f?__'• s�s_
Other land (2)
Total land(line 1 plus line 2) (3) _-
Residential Improvements or Dwelling (2) --__- - -
AnnuallyAssessedMobilel
- - - -
Manufactured Home Garage (5) _.. -?C- r__?
Other Improvements 1(6) --i:.j r -,ice
Total improvements(line 4 through line 6) I(T)
Total value (line 3 p/rs line 7) I(6)
I hereby certify the above Is true,correct, I Signature ofAaessa 6\\(� Oax si"'M(n°'114 cite*.yea.)and complete. yD Venfy6g action-Sigature°Mudtor Date signed health,day,year)
'ZW�"�+ TE STANDARD DEDUCTION'ALLOWANCE P ±`'d
20 pay 20 L.sser of 60% the assessed value of the homestead or 545,000
•
Nohvithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(lf)of the assessed value of the mobile home o manufactured home.
Signmse or i//�'�vl^L//� Date signed(can*de):Year)
DISTRIBUTION: Original-Coady Auttor,Fie-Samped Copy-Taxpayer
