Mobile Home_Valle - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
; i STANDARD/SUPPLEMENTAL DEDUCTION FORM0
StateForm 5473(R1515-14)
Prescribed by the Deparenent of Local Gvvem-ent Finance
INSTRUCTIONS:See reverse side for flung instructions. - _
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confiden I. dr! 1
P - IC: f.f-f.a7 i'i
' •`>N' • . _(!• " t rCCIITIFICATION STATEMENT •°. , 'Lk rt.. t ti3.Ic::.. I:n•-'�Y't , j-
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I(We) iCII I " AI, certify that 1(we)occupied as my(our)....._principal
place of residence or am(are)buying the following described real property under contract for which a Hom@;m4 Pj9 ndard
Deduction is hereby claimed on the date this application is signed, (datir gnMuk).'-H,We):
❑ Own. 0 Am(are)buying under recorded contract.
❑ 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 qualif -e trust .
o Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDITOR
Lk[y ell llr-liik-11LIAa:1A1. lal`E[STANE 4a ` troarra Jne
Social Searcy number of clai narCs spouse yaw five dg.E) Driver's License/Idert ea:ice I Other number Issuing Sal
of damerit's spouse(kw thetigfs)
•e'I. Y -
If buying on contract,Fee simple owner's name
Rdn:Cefs as where contract is reavded Record number Page (1j.�
I3V/r''.af �:Yk.. a - *t > ..r- . .. FrvrY' +�'-'9 srAo-y:�.c a-t I V
CouCy / Tawmlep r Tazcy d5dd(pry, R f v
� ��IjJ , 1 h%x o\
•-cal number 047 1Lag pane Is the property in question:
. (0-4Q 8 . .coot; 0 Real property �I inualy assessed mobile home(IC 51.1-7).
d any paten a the residential saudute or the land not ezcee.d g one(1)acre that im:ed'Ysy'mounds that stn re S used to produce income,describe the use and portion
0 of the pronely Udsed toproduce inane.
L )qw
Sax,Carey.and Township Is claimant vacating a homestead?
. - ❑ Yes ❑ No
Signature of claimant,- welt
I hereby certify the above statements are true,correct,and complete.
Addres of mmad(number end test 5y�5�a•'/¢end ZIP code) of faceted homestead,a any(number end greet,db.sate,and ZIP code)
Sr• W VVA Lo . i � 11CC-[1 / , 70
ASSESSOR USE ONLY • I .ASSESSED VALUE I HOMESTEAD VALUE, ;,I Now-RESIDENTIAL
Land not exceeding one(1)acre Immediately (1) ,
surrounding residential Improvements - .—+---.
Other land (2) '>' ._--j'._�."_
Total land(line 1 plus line 2) (3) -. • - - — — -
Residential Improvements or Dwelling (4) I
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6) - - 3- ;r__
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) I(8) •
I hereby certify the above Is true,correct, I Signa•'ree of Assessor Data signed(month day,yew)
and complete. cis
{7T,' T`
Ve fyvg adorn signature ofAul Y per ''LED.,
{ \'' 1„1.47. ---- -STANDA_D DEDUCTION ALL* ANCE-= A• yr_sr:*a.2 . ^.i
20 pay 20 Lesser of 60%of the assessed vaue of the homestead or S45,000 M A u
• NoM4.hstan g any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home S
that is not a as real properly or roe manufactured home that is not assessed as real properly may n,
riot exceed 1haff(12)ol•2 assessed Iue of the mobile home or manufactured hone. 9
sgnsm r GIBBON° OR
D TRlauilw: Original-County AudIr,Flo-Stamped Copy-T