Mobile Home_Chambers . CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�,,,; STANDARD/SUPPLEMENTAL DEDUCTION FORMHow�ws� (Zorn
Staterm te Fo 5473(R1711-18)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side forfiing instructions.
NOTE:Telephone,Social Security,driver's license,state identification amo;;m.",.;;,eidiffcaffon numbers are confidential under IC 6-1.1-12-37.
��(� t�� CERTIFICATION STATEMENT
I(We) �. 14 > �..Ia ►1 ` certify that I(we)occupied as my(our)principal
place of resid,iw-or u are)buying the fol owing described real property under contract for which a Homestead Property Tax Standard
I) uction is h- -by claimed on the date this application is signed, t (date of signature). I(We):
O
wn. El Am(are)buying under recorded contract.
(are)entitled to occupy as a tenant-stockholder of a 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, partner,or member of the entity that owns the property.
Social Security number of claimant's spouse(last five digits) Driver's license I Identification I Other number of claimants spouse(fast five digits) Issuing State
(Applicable only ifapplicw applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcel number Legal description Is the property in questiop:
0 Real property \ Annually assessed mobile home(IC 6-1.1-7)
any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to od income,describe the use and portion
property utilized to produce income.
Vie. 2—
6, Lk23 -e.c00 — 00
�o�
PROPERTY OWNED ELSEWHERE BY CLAIMANT
` State,fly,and Township Is claimant vacating a homestead?
`\\��`nJ 0 Yes El No
Signature of claimant
t hereby certify the above statements are true,correct,and complete
Address of contact(numberand streak city;state,and*Peode) Address homestead, at�mherarrd str�,city,a.--,and� c—^
3 6 'v_'vi _ S \U\
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON RESIEN iAL
VALUE
Land not exceeding one(1)acre Immediately I a
surrounding residential improvements (1) " ,_,.. _3- 7
Other land (2)
1 : as
Total land(line 4plus line (3)
2) t)
Residential improvements or Dwelling (4) t
annually assessed mobile l sL p i f e 20'�+ -
manufactured home Garage (5) L f w
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (6) GIBSON COUNTY AUDIT OR
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Audtor Data signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 - -r of 60%of the assessed value of the homestead or$45,000.
Notwithstanding•ny othe • • ion,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not asses ed as =: -••petty orto a manufactured home Thetis . --.ed as real pro may
not exceed one-h--I(1 . • l-assessed value of, _ ••••• home anufactured home.
Signature '' Datesilintyed
ISTRIeUTION: •riginal 'Ole-Stamped Copy-Taxpayer
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