Mobile Home_White ,sile CLAIM FOR HOMESTEAD PROPERTY TAX FORM V;°R \ I
STANDARD /SUPPLEMENTAL DEDU TIO
.7,.. HC10
State Form 5473(R12/6-03) i i I I
.' f Prescribed by the Department of Local Government Finance • Iwo I
INSTRUCTIONS:See reverse side for Ring instructions.
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CERTIFICATION STATEMENT
I(We) Ir .L—� e}' certifythat I(w . our)principal
place of r' fence or am(are) 1 Ing the following-described real property for which a Homestead Property Tax Standard Deductio by claimed
under contract on the date this ..pliration is filed, (date of Ming): GIBSON COUNTY AUDITOR
❑ I(We)own ❑ Am(are)buying under recorded contract
El Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence bust
CLAIMANT'S INFORMATION
)
Social Security number of claimant's spouse(last five digits) Drivers License/Identification/Other number Issuing State
of claimants spouse(last five digits)
CONTRACT RECORDED
If buying on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) _
Parcel number Legal description O I 1 Is the property in question:
a b-4). a-OO a yy-0O 148 3 Real property Annually assessed mo 1e tome(IC 6i1:1.7)
_ ' If any portion of the residential structure or the land not exceeding one Macre that Immediately surrounds that structure b to produce Income,descnue ma use ono portion
• of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
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I hereby certify the above statements are w n e,coed and complete. Sgnatureynant /�j "
• `/
.) Address(num••r and stcret, . ,state,and P code) - -r-
1 si h.- ... /R. 6 I • . \ .
ASSESSOR USE ONLY I TRUE TAX VALUE ASSESSED HOMESTEADVALUE NON-RESIDENTIAL
AT 100%OF TTV I VALUE VALUE
Land not exceeding 1(one)acre Immediately '»aCj�i':'; rg"
surrounding residential improvements. (1) ' �4�'e *- is '= " V''1`^'
Other land (2) Ci:?'tY 'J:
Total land(line 1 plus line 2) (3) •
Dwelling (4) S LtRh x= ATAWiie
Residential Improvements or Annually - sa
Assessed Mobile 1 Manufactured Home Garage 'F '� '`-T4 '' r
{
Q g l
Other Improvements _ (6) $r;yy.,-` vzm.<
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. lL.� '/�+
Verifying action-Signature of AuNio I�•r{, I y�`;� 1 I Y Date signed(month,day,year)
®� . ' 11-J\ STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000 /
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Notwithstanding mobile home any other provision,the sum of the deductionsprovided in IC 6-1.1-12 to a mob home that is $
not assessed as real property or toe manufactured home that is not assessed as real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Sig of Auditor
Date signed(month,day.year) /,
T.