Mobile Home_Gomez `%-, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR .
STANDARD/SUPPLEMENTAL DEDUCTION FORM 1.0t1
Sae Form 5473(R17I 1-16) HCIO
Pesa ed by Me Derr trst d Lace/Government Fiance •
INSTRUCTIONS:See reverse side tar:Ong instructions
NOTE Tekywe,Soda/Searilx drivers irense,state iderrtfthca5on and federal iderafficafion numbers ere mSdertal under IC 61.1-12-37.
I CAM- ran l - • ceRdy that I(we) • as my(our)principal
place of resid or am ) following desoii=•real property under contract far whrth a ead Property Tax Standard
Deduction is hereby on the this... is ne J. (dale 01 signature). I(We):
❑ Ana(are)buying r of under recorded lye housing
1(� Ob`� Ha�C.(are) entitled to occupy as a tenarrtstocktlolder of a cooperative txnsirg corpora '� ` \ "V
❑ a beneficial interest in the trust or the right to occupy the property under the tent of a qualified personal residence Inst
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. `
wmb �woe) �e
Seca Sonny nmhr ddet fl spans(fast fie dpih) Orisefs(tese IMondry lto IOar ranter of dmmta spare ges eve aorta tang She
µaska Se alyiapamd,spouse does non haw a adtl ssav4y nrrnPej
I ) t !Ill
Randle taro W,re tre 2019 Recant number Pape
pang; PROPERTY DESCRIPTION'- �'' - - -_
Casey 11 r ' Tatting d>gia(cdy,low;s emlrlpr .
GIBSON COUNT AUDITOR
Patel furter legal msrp:a1 Fs the property la question
0 Rey ptcprtr ❑tunny assessed made lorry(IC 61.1-7)
It any pram of the resdrtd tare r Me land it exceectno one(1)acre tat mmeriaiery armada that structure u meal to produce moxre,desate the use ad portion
d the meaytdr¢ed b I»aa scone.
16 ^ 4aY' =o5 166 -0 o
-` PROPERTYOVJNED ELSEWHERE BYCL'AIAIANT .. ., =.- , --
-
State Coady adTov a
tip IsclaimantvacatingaIn...tead?
❑ Yes ❑ No
A -acumen
I hereby certify the above statements are true,correct and nomplete. , . 11 i
AbLm of Monberrxt Meet city,axe.and ZAP code) ••._�of m±ed �..._t_��.. ay(ex,,,larrd d1r andzwwA>
322 .W .c l's site 'r v\ an—
. -ASSESSOR USE ONLY V _ -i ASSESSED VALUE, V f. .•HOMESTEAD VALUE I t NCO-RESIDENTIAL rJ RESIIDVALUENTIAL _a to '
Lend not exceeding one(1)awe Immediately - i IVn
surrounding residential Improvements (1) ,-r°� _ s, 'tom-,,.,.'y,
Other land (2) lactit:c ...-
Total land(line 1 plus line 2) (3)
ay
Rnually asessadememew DreOhp (4) ice:._-..... ;T.._.,Va..°..._:`-'
annually assessed mobile 1 q
manufactured home Garage (5) r.•._ zz_,-:ai:,5z;--yf:._ :-.
Other improvements (6) _ ...: _ ,1
Total Improvements(line 4 though fine 6) (7)
Total value (line 3 ptm line 7) (B)
I hereby certify the above Is true,coned,
Sigreexe dAuavr DYe yam(nith nay,lead
and complete.
Vatf)tq deep-Scenes%of 41.1dhcc Cate aped(north day.few)
- -. . . _-. .a STANDARD DEDUCTIOtJ ALLOYJANCE. _- ., __. . . .•
20_pay 20 Lesser of 60%of the assessed vAue of the homestead or$45,000.
arthathstar d g any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed oonhaff(laird the assessed value al the nob*hone wnwsddNued home.
Sg�xe dAtldmr Dar' *PM(en'L1,�;�
S �U•MSVA- _ l_ -19
DISTRIBUTION:Or9ird-CmdyAuedar,FaeSlalped Copy-Taxpayer
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