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-&ed Copy-Taxpayer
