Homestead_McIntyler , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 ‘"-;; STANDARD/SUPPLEMENTAL DEDUCTION FORM
'� i Slate Form 5473(R17/I-16) MCI �`
%Bear l Pmsabed by the Cepanment or tag Government Fiance
INSTRUCTIONS:See reverse side for fling nstmct"os
NOTE'Telephone,Social Security,driver's 6censa,state iderfifficadon end federalidert5cafon numbers we confderdiat under IC 6-1.1-12-37.
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I(We) J vt • • certify that I(we)occupied as my(our)pnncipal
place of resit or am(are)buying th ' desaibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed b the date this application is signed, (date of signature). I(We):
&(are) Am(are)bagg under of a rebated cca act
(are)entitled ro ar icy as tenant-stockholder cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am(are)the shareholder, patter.or member of the entity that owns the property.
I- • CLAIMANT'S INFORMATION - ' . -. .
Sacral Starry rumba of dermas spouse past five dq a) Orite's Using S aaxas/ vti:aYmn WearWearrexi dasnae's pee me Iota State
(AryFaHe oryie/pkmdsIe scam rim rotof haw a spouse sMemvrymate)
If tune on contract Fee Serape otters mane
Remrtlers ohm Where artrad S recorded Rant molter Pape
_ Taxing
\ I - -'n-. - PROPERTY.OESCRIPTIOV'-'f _. - _ ..
ll :N in y \ TaxingIshii(city,tam township)Pa¢I te.,uer Q lap+ 1desaipflam n question:
Reg lxrpeb 0 Arm*assessed moots tole(IC 6-1.1-7)
If any parr d me resieaeal=nee a ma land not roxeeaEq one(1)ace that nenestructureis usedtoty structureproems iron,desalts e me end calico
d the froct+h'rb&eamPod+os6mo .:__ ' C_—O0 - yo3 -tJ L . 2bff—o zg ,
" . '• " - '=< - '' _'PROPERTY OWNED ELSEW'dERE BY'CI"NIAIANT m .`
- ':- -3 ,, . --.. -'r '�- -- '
Sam,Cany,aid TownshipdTownshipis claimant vacating a homestead?
0 Yes 0 No
I hereby certify the above statements are true,correct,and complete.Y �/��
At dmrraa(aa,maa,tfo.e.wfst.and npmd_q /\ dL�� Jj ra.teheet aezems)
t(112 , . s'r • - 1 k-n-6-10
-ASSESSOR USE ONLY ASSESSED VALUE . .") HOh9ESTEAD VALUE -.: .NOtbRESIDENTIAL r'=
-- _ ;' i rl + - 1 ? -'-"VALUE _ i5`
Land not exceeding one(1)acre immediately -E- -t
surrounding residential improvements (1) 4<_ r_<`
Other and (2) '-.�p3T y�,l'u?'
Total and(lire I plus cute 2) (3) F I p fF1
Residential Improvements or Owemng (4) 3B.J+ tl�/,��rr K `
annually assessed mobile I
manufactured home Garage (5) e "5,. "� -
Other improvements (6) Y . _��N-yl �;20ti
Total Improvements(line 4 through line 6) (7) ,l� - f
fradTotal value(fine 3 pea line 7) (S)
I hereby certify the above is true,correct,
Signature Of Assessor GIBSON COUNTY AU R(t+odAaey.yeal
and complete.
weans acaah-straits oAudte oarssued(mote day,yea)
..- F _".'- °STANDARD DEDUCTIONALLO1VANCE .•&n; .. _. _ r_.r
20_pay 20 Lesser of 6096 of the assessed wive of the homestead or 145.000. [
NoMiths armdrtg any olherproviion,the sonic(the deductions provided in IC 6-1.1-12 to a noble hone S
that is not assessed as real property or to a manufactured home that is not assessed as teal properly may
not exceedonehe!(1/t)of the assessed value ofmobiler:the home or : .. home.
Sane
S Sol \ I : Cam' Dat`sf 19
DISTW8U1iON:Original-Canty Auden,Fie Scarped Copy-Tapeya
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