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Mobile Home_Smith .. - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR nn STANDARD/SUPPLEMENTAL DEDUCTION r^ State Form 5473(R15/5-14) ' 1 :-` Presented by the Departnent of Local Government Finance INSTRUCTIONS:See reverse side for ring instructions NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. c CERTIFICATION STATEM (, -ENT' :--..,'.--7.,S tm- i'il. c' '_ '_ I(We) V, dtr.ai�', 41 ',. a s r certify that I(we)occupied as my(our)principal place of residence or am(are)ibuying .-following described real property under contract for which a Homest Property Tax ndard Deduction is hereby claimed on the date• is application is signed, (date t. • i can. 0 Am(are)buying under recorded contract. GIBSON COUNTY AUDITOR 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 trust _ ❑ Am (are)the shareholder, partner, or member of the entity that owns the property. -_. _:_`_ ..-.. � rG1:AIMANT;S INFORMAT10Na cs s _ lift?z_ _ A a Name of da'unant(legal name) - Social Stay number of claimant's spouse(last five digds) Driver's license/'dentiraion/Other number Issuing Sate , of da.ant's spans Pan The dies') - 'i 41' 5. 17(gri;_=' C.f.:_.c; :- -'.CONTRACT.RECORDED .�t:FFt`.'�_!' 1:" re-:_ - I buying on contract Fee Shape owners came sRecordr's oZce where contract isrecorded • Record number Page 'file LJ.4i.-erk,e:6, 14,-LY "'S .`y4tY..PROP -TY DESCRIPTION-. :i5:...s`.i} .,G�i.`maaAc.L`1 ,`;,."d -4 County Township J�J Taaing Tid(city.town,tcwnship) afAr P: b 4?aosp(/K`9" r�T !erg-I� Ia the property party or1FLrT^siT 1, — ❑Real property MnuaAy assessed moWe home(IC 61.f-7) If y V anyn at the residential caa or the e b nYJI ezcee0h caw c Mace that immediately surrounds zoas that isto am income,used odu desciEe the use andportion pani it of the paPvc lCS6ed to ae7ppe income. , ADDCstiaa - - ot)a PROPERTY OWNED ELSEWHERE BY CLAIMANT. _ . _ _ _ c_ Sate,Carey,and Township Is claimant vacating a homestead? . Yes ❑ No .Sign claimant t Signature d I hereby certify the above statements are true,correct,and complete. te Address of contact(number end street,rimy,stria,and LP code) Address of vacated ban .eat,d any( ,and ZIP code) Ar Od a :.Z ner t- i enis-%/ r~re _ ASSESSOR USE ONLY I :.ASSESSED VALUE HOMESTEAD VALUE I. NON VEASLIUEHiIAL ' Land not exceeding one(1)acre Immediately (1) • --' -- surrounding residential Improvements - Other land (2) .' 2 w, ., �„` .- _ Total land(line 1 plus line 2) (3) - - — _- Residential improvements or Dwelling (4) I r I V- i y ' Annually Assessed Mobile) - _ Manufactured Home Garage (5) _ .: t1-,;2Y% - u Other improvements (6) Total improvements(line 0 through line 6) (1) Total value (line 3 plus line 7) (a) I I hereby certify the above Is true,come t, Signature of Assessor Date signed(month,day,year) and complete. Vetyeg adorn Signature ofAud':tor 6 7 Date signed(month,der. -a AA r _'•:-'+^tf fir z_:r-re: STANOARO DEDUCTIONALLOWANCEM:,- CeecT7 s.-. rknct=+-W4cl;.1. 20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 � Notwithstanding any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile home s DEC 2 . 2016 that is not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. SNnrire oAuor Data signed( day ye 3-Q 0 „' _, 2_ ,(NS G� ou AUDITOR DISTRIBUTION: Original-Gou y P•.da.Fae-&amped Copy-Taxpayer