Mobile Home_Miskell (2) II �
4' CLAIM FOR HOMESTEAD PROPERTY TAX FORM
HCI 0
I YEAR
FO-;f: STANDARD /SUPPLEMENTAL DEDUCTION OR
State Form 5473(R12/64)9)
°w Prescribed by the Department of Local Government Finance
{a
INSTRUCTIONS:See reverse side for filing instructions.
'CERTIFICATION STATEMENT.- _ '
0 I(We) ' / I ia(t '..'� . / certify that I(we)occupied as my(our)principal
place of reside ••• or am(are)buying the following described real property for which a Homestead Pso$eLt t Tatd rd Deduction is hereby claimed
under contract in the date this application is filed, (date of filing): b Q
E I(We)own ED Am(are)buying under recorded contract
GIBSON COUNTY AUDITOR
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
. CLAIMANT'S INFORMATION - . • .
•Name of claimant(legal name) T /� fee_`J\ CXb'on A-, I 'rn' 1.S Jae_ )'
/Y L/
Social Security number of claimant's spouse(last five digits)j Drivers license!Identification/Other number Issuing State
of claimant's spouse(last five digits)
- - - - CONTRACT RECORDED .
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
. PROPERTY DESCRIPTION •
County Township Taxing district(city, o wnship)
rue
Parcel [u/mb'err pI �1.� p� Legal desolation /, p{'�/ Is the property in question: i�.�
026�/ 2) of Q t�w cLl /n 5 N /\ ❑Real property 1]tiAnnually assessed mobile home(IC 61.1-7) '
e any rtion of IAK residential stmctt&re or the land not exceeding one(1)acre that immediately surrounds that structure is used produce income,describe the use and portion
of the properly uslaed to produce income. l'
. .PROPERTY OWNED BV CLAIMANT IN OTHER COUNTIES.
County Township County Township
I hereby certify the above statements are true,correct and complete. �gr}a :claimant �y ,1 •
dress(number and street,city,state,and ZIP code) r / L/iGJ �,✓L//r[L(L(��
Sort c L4 ' i.e. aYlifc `/7(a 70
ASSESSOR USE ONLY . -TRUE TAX VALUE I AAT E00%OF TTVE I, HOMES VALUE AD I NON- ESIDENTIAL
Land not exceeding 1(one)acre immediately i ,," C y tfV n;-
surrounding residential improvements. (1) tJW...;r . r zN_ -�
eOther land (2) c W (-
Total land(line 1 plus line 2) (3)
Dwelling (4) Y':!4: ,s+4„ .Y! -ii''4'i
Residential improvements or Annually sr -c""s`a"t:T
. Assessed Mobile I Manufactured Home Garage (5) hnel"w ��?�"' '{. x °?Ott:.-.—S,Attrciti.Xt.ttrctft&SSAYZ,Vs.ttt
Other improvements (6) la;- -'::Fi";ir,°_
Total Improvements(lined through line 6) (7) °
Total value (line 3 pits line 7) (8) \
I hereby certify the above is true,correct, Signature of Assessor \ I Date signed(month,day,year)
and complete. \�(
Verifying action-Signature of Auditor \ \, \ \\J ' \\ ,� I� Date signed(month,day.year)
. - : - . -_ STANDARD DEDUCTION ALLOWANCE - - -
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
\\ NMVilhstanding any otherprov s on,the s sn o the deductions pm clad in IC 61.1-12 to a mobile crone Nat is S
lv not assessed as reel properly or fo a manufactured home mat is not assessed as reel property may not exceed
'^/IV]11t` one-half(12)of the awed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day.year)