Mobile Home_Hart (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i' '1 STANDARD/ SUPPLEMENTAL DEDUCTION FORM
i State Form 5473(R13/12-09) HC10
'1/4" 4N`rit Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. t,
B,Vit Utc t■itAl. Zt <"_t3A,`'fitIst ha _c CERTIF.ICATIDN'STATEMENTS'•:„'-;F"'a,.ei''x i' _ : aZ24i ar iC xs st'n
I(We) �1. .er��:�7t♦>♦Gn. certify that, ( ) .M i-., (.1 W ndpal
place of resi•ence or am(are)buying the following desrlibed real property for which a Homestead Property Tax Standard Deduction is hereby claimed
ler ntract on the date this application is filed, (date of filing). I(We): MAY 7 2 12
Own ❑ Am(are)buying under recorded contract
❑ 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 tnt .
❑ Am (are)the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
Vleiei ';,,1-` ..t ,"...-sfi*#, y --m 4:4 `'�{„' .}s .. y. CL'AIMANTSJNF,ORMATION„.igc,:ific'.,... 3,^;a.`7` _.atizli{ei?` N ;.Tt- -.-s�° ii-v-rvai
Name of claimant( ,name)
Social Security number of claimant's spouse(last five digits)
1 Driver's license/Identification/Other number Issuing State a
of claimant's spouse(last five digits) je i�,
,/•? ce..
2..':e74:1 s f t . ili t z+ f ` azieiCS+ COTRACTeRECOr DED iii i;A'A ;t2x. r.:?agia1 St. c ;k.s .r. .7l:
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
Q'3 "`.. ,.,::::..,.,t_ k x - IA writ, <2. t1i PROPERT-Y.DESCf21P,TION .c".Y-f.:ill tit,r.;.a9ei:i;fi.!tS-gr<.":,A.jil_.'.l' aSW!t?.;
County Township Taxing district(city,town,township)
Parcel number Legal description M Is the property in question:
'"'W 12&b 5033 a, / ! / I� ❑Real property ILNyAnnually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
n.,-. ,.x,Yi^trig ':VI1F 1 iiiiCS ri,7C-y"'PROPERTYrOWNED BY_C L`AIMA.M1T7::IN OTHERrONNTIES'i 'itic +�: li..'�rLe`-�;. i-2::: 7t:
County Township County - Township
I hereby certify the above statements are true,correct and complete. Sig of claimant .r
Address(number and street,dry,state,and ZIP code) /{•,,(�•+w7V�
`'v- -. . t n a z r< w4t, at >'y T t' + ASSESSED VALUE,.Il'v"HOni -. EAD.e �{ yNON RES;DE N TIAl �,i
.irYA ,. ASSESSOR USE ONLY�t 4+ t � TRUE T VALUE �,'AT=100 r,OF.TTVA Ran AVALUEtY4Ill. i s tr..VALUE.cc-r}.i:i-:Mi
Land not exceeding 1(one)acre Immediately
wrounding residential improvements. (1) �y y ,� _ v =
-- .� �$ -
y,
Other land (2) -ayf
a,�sTa,
Total land(line 1 plus line 2) (3)
9 ( ) �s i^ :. ?ma ? `r. Y'?i
Residential Improvements or Annually
Dwelling 4 . �; ya - .ey-r ..;;,
Assessed Mobile!Manufactured Home r3 u- fif%=, f s± `=Cure e (5)
Other Improvements (6) ti 3V." l31,,r
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,yew)
and complete. nt
V
I et
aifytxg action-Signature of Auditor \a \"Y \ II Date signed(month,day,}roar)
a tic°'n :r:.`_ ir- egili' f&A :c-4s?s, y�i, STAND ARDDEDUCTION,ALLOWANCEn', .,`_s,- ifkiCrx Scril PX24t1f na'4s; - it7A!R
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 properly or to a manufactured home that is not assessed as real property may not exceed -
ore-heH(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)