Homestead_Fitzlaff ,T CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD 1 SUPPLEMENTAL DEDUCTION FORM
r State Form 5473(R17t1-16) HC10 20 C1
Resabed try to Department d Lori Government Fame
INSTRUCTIONS:See rewrsa side torOng alsbudions.
NOTE:Telephone,Social Security,diver'license,state icinellicabon and federal iderr n numbers are confidential uxler IC 8-1.1-12-37.
CERTIFICATION STATEMENT •
I(we) I�Q `'In. r lkl .�hI C7 11 ' ire- . that I(we)occupied as my(our)papal
place of residence or am(are)buying the following desmbed �, .....- a.. 11:r4 farwhidh a Homestead Property Tax Standard
• is hereby claimed m the date this appimtion is signed. (date of sigfraofre). I(We):
• Own. ❑ Am(are)buying under recorded contract
Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
`5 El Have a beneficial interest in the,trust ust or the right to the properly under the terms or a qualified personal residence bust
-�fjT''y 0 Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION _
Jr Qpwweraak
1}/n1r'
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Sodtl Seemly Imam of dammfs Aane(ad am casts) Drivers acne I IderdhcoCin I dater ranter of derm2Y spouse(lax Nee duds) tsskq Shea
hate q 11 Il Me ao®I scarily males!
IfttMg m contract.Fee Simple oats name
Reorders office where ccmadisrecorded FEB 11 2019 Record number Page
Gash ToweRy oh;t nt wnmd0)
GIBSON CO NTY AUDITOR
in(ranter Legal dr.repton is de PoPmy in sash=
0 Real Rcpety 0 A,'aaey assessed male mere(IC 51.1-7)
If any portico of be reddened Cedars orate tap. emeeing one(1)macs vat innedSdy enomds that&anew'nused b polo iCYra desoibe tiro tam aid portion
of de popsty reared b pods&in
C/—aZ-o7- 1o� —oo2 . 307 . �2S' .
PROPERTY OWNED ELSEWHERE BY CLAIMANT ' _
State.Cotady,aid Tomahip - is tl jnl vacate)a homestead?
Yes ❑ No
Sonairs of claimant • t
I hereby certify the above statements are hue,coned and compete. _sec f
Attd minsa of d(amv lbad meet dbas'e> .mad Went) .• - .:vambtl a-.... dory / .ab,sale.and VPmb)
Nr.._A .
ASSESSOR USE ONLY _ _ i ASSESSED VALUE ,i HO.MESTEAD VALUE :_ _ NON-RESIIDENTIAL
Land not exceeding one(I)ace Immediately '- .�ti{-^
Surrounding residential improvements (1) t - �- :iVe -t c
Other land (2) .tsV};}-,€c _.
Total land(line 1 plus line 2) (3)
Ilarvirrilfi12-2
tat improvemenRa Dwelling (4) -..--':>- �__ '31
annually assessed mobile I _
manufactured home Garage (5) w, -a
Other improvements MI _W-4.4-__;n.zW.
Total improvements(line 4 through line 6) m
TOal value (line 3paw Erse T) (8)
I hereby certify the above is hue,corect, Syaase dAuaz6a Data siaead creak nix real
and complete.
Yaayig action.Siamese olAldxe Data sVsd(nest day.yam) -
STANDARD DEDUCTION ALLOWANCE -
•
20_pay 20 Lesser of 60%of the assessed vaue of the homestead or$45,000. .
NOMit Starafifg any oterprovision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S that is not assessed as teal properly orb a manufacturer!home that is not assessed as seal property may
not exceed one-hal(fdZ offe assessed value of the:ob&home or manufactured home.
Square dAudbr Date slped prat dry,year)
s}seduk
DISTRl&I11DN:Odpi s-Cann mores:,Fie-Stamped Copy-Taaprya
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