Mobile Home_Fryrear Ze CLAIM FOR HOMESTEAD PROPERTY TAX YEAR It STANDARD / SUPPLEMENTAL DEDUCTION FORM
iHC10 State Forth 5473(R73/12-09)
, Prescribed by the Department of Local Government Finance `
INSTRUCTIONS:See reverse side for filing instructions. -
rt ,: /7�7 ICERTIF,ICATION STATEMENT' _ _ _ -,
I(We) 4Ja k . .- . t._ *A`-� L ' i fy a't (we),” p. `my(our)principal -.
place of residence or am(are)buying the following described r-1 property for which a Homestead Pro.'- -. finial.; se•uction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): DEr 213
1
Own ❑ Am(are)buying under recorded contract
T Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation n'
I ❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified e trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
e .:q r€ €,: 1r`' ` ,4-:i -3-`- �'�it„`�"".'�.""_ iS WFbRMATION - ;c am_. ':"f L' s'..:to
CLAIMANT -
Name of claimant(I-.1 ame)
4 Q/k/k-oC- 9 /LC-d-1,
—+—' 7-
Social Security number of claimant's spouse(last five dgits) Driver's license/Identification/Other number State
of claimant's spouse(last five digits)
-
- - :. - _ - .. �..._- F .�. _i;; =�._„!CONTRACTIRECORDEDr.•:T: _ A. '' _- _ .c .�"_.
If buying on contract,Fee Simple owner's name _ - f
Recorders office where contract is recorded Record number Page
_ c RP OP,ERTY.DESCRIPTION -.- a ._ : - .. _: _Y -
Coun N1 Township Taxing district(d J ,t• ship ft
" ` 1Ii L., r n( IllO._
Parer) cumber Legal de don Is the property in question:
p[EQ—Y-t . --eCQCO/ _ El Real property Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)aae that immediately surrounds that structure is used t produce income,describe the use and portion
of the property utilized to produce income.
S
:_t PROPERTY OWNED;BY CLAIMANT IfJOTHER-COUNTIES, a; . sr
County I Township County Township u
I hereby certify the above statements are true,correct and complete.
Signatu claimant • .
Address(number and street,city,state,and ZIP code
�C1� 6: a•v'r' 9� . C_)..).3....0.),....., &•1 :\\ I t\ 6 • -
="--" ASSESSED VALUE -HOMESfai NON-RESIDENTIAL
ASSESSOR USE ONLY TRUE TI VALUE
+. r . - _ - ,ATt=100 ,CiFirTV_ .:.VALUE .-: _.VALUE .-.Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually
Dwelling (4) .. _-
Assessed Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete. \VY,\ (fl
Verifying action-Signature of Auditor \ \ \1\\p Date signed(month,day,year)
- y 7.'$T4 NDARD.DEDUCTION4L0WANCE, Y, _ - -_
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 $ ".t
not assessed real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1R) i assessed value of the bile home or nufacrured home.
Signature of to Date signed(month,day,yea
A,tt. /01-a7-t