Mobile Home_Lindy port. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
c_ n E STANDARD/SUPPLEMENTAL DEDUCTION FORM
+ -; Srae Fum 5473(R1711-16) HC70
M`f-i'l Resaited by the Duet a lord Government Fiance
INSTRUCTIONS:See reverse side Airfing instructions
NOTE Telephone,Social Secretly&Nets grease,stab,idert5rabon and federalldertfoadon numbers are ord*ntthl under IC 61.1-12-37.
® I(Wa) • certify that I(we)occupied as my(our)principal
place of residence (are)bag the bed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed an the date this tap • is signed, (date of signature). I(We): .
❑ Own. 0 Am(are)haying laden recorded cadract.
O 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 oo ipy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION ' ... .._ ' -.• . -
So®I Security tombs of dammri spouse(last fire cleft) omen Sam I Identification I Other number dde'vvn's spouse(as(five repts) tsav9 Sae
NaPacade o.?rdapl is seam does rot Save a sotld seasty amber.)
e t :-.51
- nil.- ••_ ,•r t•nNTonCTiRECORDED c' - _
t OMNI on ceased.Fee Simple mars kale
i i
Rebedefs slim where carted is recorded mimed nutter Pepe
Cunt Township ///1/�n..•Toting detect(sty,item tetuhb)
f�'IrM' a r�li
Patel rummer ', GIBSON COUNTY u PraP`�"pn9t `
II any pueblo/the residential Ware or ere land not emeetop are(1)acre that mmedmey surorrds that structure is used a produce
/S�p�yre and Tin
Ill al to proptty uftzed to poduce bane �I
ig‘— yl1 -os op-r-oo
I, 4-..ernes--..w.r.- • 1. r"-
Sta.sty,End Tom Is claimant vacating a
❑ Yes El No
I hereby certify the above statements are trine,correct,a complete.
- rC—ILmte 1 Q� ) '/ ' .
.. __ .. ..--(rsmtvrsfabM atl:sYe,rdZlPmde) Hrj r (r._- - ..-•,•hammed—a ere Kstee4c :rate. zroaade)
b ASSESSOR USE ONLY t i ASSESSED VALUE i 'HOMESTEAD VALUE _ I t10 N-RESIDENTIAL,
VALUE
Land not exceeding one(1)acre 4nmetlIatay ,V- l+ -
surrounding residential improvements (1) . ._y- P `4jY76 .2-.74%
Other land
Total land(line I plus fire 2) (3)
Resldenlal aupoternerts or Owning (4) a____ _T i 3' .ems-,«,r.
annually assessed mobi%/ -"' - =..
manufactured home Garage (5) - F x -' :i;r
Other Improvements (6) -,r_t<<_:•.:t L_).r_-,,,. ,iz-1:
Total Improvements(line 4 through line b) (7)
Total value(line 3 plea line 7) (8)
I hereby certify the above is true,correct S re cAssessa Date Signed(mrdt den;stem)
and complete.
Verifying aeon-Sonatas of Milts Oats signed(math day.mar)
_jam '; l3 "-'fin^ - STANDARDDEDUC11ON ALLOWANCE"? a '.^ e '4
20 pay 20 ,W Lesser of 60%of the assessed vrtue of the homestead or$45D.
IIINMp7hslance g any other plows'ton the sran of the deductions provided in IC 61.1-12 to a mobile home $
gigot not as real popery o to a home Nat is not assessed es real propery may
not erased one-h WCa sites edvitae of home ornnaidceue0 home.
SpraredAxis - tea signet(month elge)err)
i g
DZSIm8URON: -Casey Assenr,FeeSalalyed Copy-Taxpayer
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