Mobile Home_Phillips (2) { 47. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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STANDARD I SUPPLEMENTAL DEDUCTION FORM
state Form 5473(R15/5-14) HC10 /
Prescribed by the Department of that Government Finance I
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INSTRUCTIONS:See mvarse side for hfrg instructions. - ' 1 1 (�
NOTE:Telephone,Social tsa id Saucily,tlme5s thsin, state identification and federal identification numbers are wn5den i d IC 1.1-1 7 -9 I ,^//''y
1 _ •' /C�ERTIFILATION STATEMENT:: - 't�I /1"11 T'7 I �. )J art
I(We)i r wC+ cu1l I a (4.A /r a-) -My that I(we)occupied as my(our)principa
place of residence or am(are)buying the following described real property under con -ct for which a Hom te Pjppe�1��ndardd
Deduction is hereby claimed on the date this application is signed, (datr�i nq'ure)LitWe):
❑ 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 qual ce trust .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDITOR
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Recorder's office where contract is recorded - 1 Record number Page n
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County Township Taxing dsidtl Iota sfowrrshy) \tV
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Parcel r.-nber Legal desairrg000.s./.o X A S �.�y. Is the Property in questen:
II 1 9./ /-t t-- /Ip_ r "s ❑Real poppy "sly assessed rr a home(/C 6-1.1-7)
C an por of the residercal cuCire or the land not exceeds";c e(1)arse that'.-edatrty surrounds that sbWtue is used to produce'urnre,desmte the use and patton
of the property utltred to produce boom .
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State,Cony,and Township I Is claimant vacatng a homestead?
- ❑ Yes ❑ No
J g'� of claimant
' / I hereby certify the above statements are true,correct,and complete.X /-
�/ Address o(mnxd(number and eet.grtiY.Sere.and ZIP dada)
`r i ddress-_Gof vacated homestead,R any(number and.meet city Sere,and ZIP code)
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ASSESSOR USE ONLY ti I ASSESSED VALUE_ I •-'HOMESTEAD VALUE . :.'NON-RESIDENTIAL' '•
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3) -. . . I - - —' -
Residential improvements or Dwegb"g (4)
Annually Assessed Mobile/ - - _ _
Manufactured Home Garage (5) ~
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs line 7) (6)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(month,day,year)
and complete.
Vetys g action-Signatre ofAUdtor n Date signed(rrmh,den year)
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--4_-„�l�°•t -STANDARD DEDUCTION ALLOWANCE �_i�� g�°�!�'r"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 toe 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(12)of the assessed value of the mobile home or manufactured home.
Sigma', of� / /^y/✓ Date signed(rnwh,ear.year)
ol5TRlatrtoN:Original-Corry Audar,FieSa r ( �Q