Homestead_Byrns ^ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
x ;; STANDARD/SUPPLEMENTAL DEDUCTION
FORM •
'w ' State Fain 5473(R1711-16) HCIO
•
Prescribed by me Department a Local Government Finance
INSTRUCTIONS:See reverse side for tiling instrucfrons
NOTE Telephone,Social Secr4tl amens ece,oe•Wide bien65ra5an and fetal identrWWOR numbers we roe,dential under IC 6lp(ay?ENTERED FOR TAXATION
/� • tance for transfer
I( ) 1 1 W\W P 4 r'h5 certify that I(we)Drnl o kleA. Cr
place of residence or am the desatbed real( property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed an the date fins application is signed. (date of Lora). I(We):
Auditor
❑ oymL 0 Am(are)buying under recorded contract. Gibson County
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a benefidal interest in the trust or the tight to occupy the property under the terms of a qualified pp-mg!Tsidence lust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
'
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l l( •✓ i/ • ice 1 o Ta'v+g timid(orb town,bamNo)
totlrunbsr lags dasviyem 1 Is MEZZO prcp.O n Weibel
pcpely 0
Iwemey massed mote.Ilya(IC 6-l.l-7)
If am person dam re*jeeGs slue or am Iand rnt emectre are(I)err that i mvatatly wan an rsrruae is used to omen borne,desate Meuse ad portion
d the prpety utilized to pmda:mere
a‘D-\'-oat-aoo — oo Lk icy— oar]
t�t.?`. > ice'-_"- - ,PROPERTY OWNED ELSEWHERE BY.CL'AIMA NT ` !nt _col.,
Ste.Cornsy,end Tantstep Is dalmani restead?
❑ Yes
aware a cabal
I hereby certify the above statements are hue,coney and complete r/d/.���/y//y fr„ �J( .
iti...bind(numbs-ant street coy,soh aid ZIPmQ) ckress a Aga lane.a sty�sbat.MN•she.att IIPmde)
9
�(. l al •i S Ilk •
_
vA- - .. ASSESSOR DS •NY -r .:. I '.A a • .' 14 ari .nT. - I :f NONRESIDENTIAL .
Land not exceeding one(1)acre Immediatelyrro .,4..'
surrounding residental improvements (1) , -v .._r-.k _. -
Other lard (2) 5 _, 7:.`
Total land(line 1 plus line 2) (3)
Residential bpovements or Dwelling (4) 4 a^i2,--r `s`"}:
annually assessed mobile I ""`$ - - -:':
manufactured home Garage (5) c k r z l- _'F' d
Other improvements (6) (
.-> J'a.g
�4L
Total Improvements(line 4 through line b) (7)
Total value(line 3 plus line 7) (6)
I hereby certify the above is true,correct, Signature ofMsessa Dam signed(nxurh,dry,year)
and complete.
VHatrng.raon-Sipuuae oiwaXe Data signed(nods day year)
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`27..s.•'hR:yy2tAri L'P'-:_=.ii St,:SA3.-7 . . s - - w�eti s�.c' ..�,c,�w•< -;�
20_Pay 20 Lesser of 60%of the assessed value of the homestead or 645,000.
NethwThstarang any other provision,the sum of the deduction provided in IC 61.1-12 to a monde home $
that is not assessed as coal property or to a manufarhned home that Is not assessed as real property may
rat exceed orwhal(1/n althe assessed value of the rmbilefln
or manufactured home.
t dHrdbr Date sigretl(mvst day,tea)
1vv -� c. It tom— Ik.
DISTRIBUTION:Original-Casey Aker..Fee-53mpad Crpy-T
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