Mobile Home_Dillonr
,€--- CLAIM FOR HOMESTEAD PROPERTY TAX V FORM YEAR
+y STANDARD/ SUPPLEMENTAL DEDUCTION
g.=�?-vi• State Form 5473(R13/12-09) HCI 0
792'- Prescribed by the Department of Local Government Finance M
' INSTRUCTIONS:See reverse side for filing instructions. I 1 111 5
....4.416a g:..'cc- '.k tz 3'->F*:><_"-`ii fr;: "�`._N.d' tigr 'V CERTIf,IGATION_".'STATEMENT -tA=Ig ..e ^3i -r • - ; C. ..;l
I(We) e l n e W[. / O 7<-) certify 1 t ( I)• . as ;BPI principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
e'er contract on the date this application is filed, (date of fling). I(We): AUG G 1 rr .1 C 012
co
glOwn ❑ Am(are)buying under recorded contract h4 u /
p Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation C. .
❑ 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. GIBSON COUNTY AUDITOR
viz? - a' e' r• .- �ci'� ;:r r 1 fi'`4 r - -, fiat: M' ±..1.
T+} � /a-.n(�y��e..p2a:�lsr^4.:azv'i.s , .Fs<w_.6 e,. ,�.,. _.� CLAIMANTSINFORMATION t....E..,.- ..-t.i.�(',.}y.�..s-.� '{.r!.'.� x=ir .:..i;..:�ftt
Name of da'/ theme I .ry l
Social Security number of claimant's spouse(last five digits) Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five dlgrts)
W ( -.x y. x -.',Ag: a t ha• .y= r-u'"-i- X' z - n St e r - Ys >y -.:.
.3 ..s;•. {._ i:-•,> ..sr _t-�..t -.F2;:.:.�.:�.i.L S.�`• CONTACTsRErORDED .,.:ss<..s:KS�v.. �:...^"Si;��S*r;t F{.v.,e�S.E.niS: . r '<.�i:
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
4 a. ., =.. , .Kv,e`,r,.-;t4li ti's-i;ttie�1Xs:h` .r P.ROPERTY.DES'CRIP,TION ?Zi:a..v_--clA_15`5.0 .4 w'r".<,L; :ii.l tr ..,s 5^ti.�
County Township Taxing dis-d ty.t con, ip)
Parcel num �),{1 ,c.,G/ Legal dessAptiioon/ yL/J//1 Is the property in question:`1q/7
016- r�G- 0(13�/' , / / 6 / a f I ❑Real property *Annually assessed mobile tome(IC 6-1.1-7)
If any portion of the residential structure or the turd not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the
T property utilized to produce income.
?t:_r .4?.0 i..r <ti ?.::.. ..',_..4:f xf?ROPERTY OWNED-6YrCLWMANTr;(N OTHER{COUNTIES,. :gi ‘"1r1„r f..r`r�.,.e=t::,
County Township County Township
I hereby certify the above statements are true,correct and complete.
Sig tu of claimant
•• -, (number and street,cdy state,and ZIP code) � 1 /
('I 4r/ 3 t At r e ( 1e9r0e
.r � ' i r r .aw+ 'ry f 4 r-r 2 y+••c �`1' i ASSESSED VALUE','%HOMESTEAD:a r jat'tNON RESIDENTIAL f ':'
a�4,.? 1:41.4=ASSESSOR•USE ONLYt:S iS..Iiiti3A1TAX VALUEMI.:AT_700 OF TTVL...('�z�.VALUE>sF_.�. f-!-34.61;.42 VALUE fc.ms ?>h '.
Land not exceeding 1(one)acre Immediatety '' "'k`"� "°' �- "�'k'
surrounding residential improvements. (1) -`..� .44.-Yi`�� '
Other land (2) ?-.i<se_
Total land(line 1 plus line 2) (3)
X 7 , e Dwelling (4) +_~ - ;° ri r Y
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) ,,,///111 t<v-.kt t k._' t ^3
Other Improvements (6) ` to - +;?,y �#�
Total improvements(line 4 through line 6) (7) {,}\\
Total value (line 3 plus line 7) (8) \ J\\ \It
I hereby certify the above is true,correct, Signature of Assessor \V1\\o1 I Date signed(month,day,yeah
and complete. •Vaifying action-Signature of Auditor \t\\ Date signed(month,day,year)
:",.*, - c K3v i.r-:5". 3'1f=%.�'t�:':5,:i10iSTANOARODEDUCTION:'ALLOWAINCE=Ii.a"Saa ..rrA-7,t.:a:9y?fin s. :di S":
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 that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
- - --
one-half(1/1)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
InlIggra.....— - i. __.____ -