Mobile Home_Moore CLAIM FOR HOMESTEAD PI ._____ TAX 'Yeast
`" .rA Fad STANDARD/SUPPLEMENTAL DEDUCTION ��
,t•�
>any State Form 5473(R97/1-16) HCIO
Prescribed by the Department of Local Government Finance l
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identibcation and federal identification numbers are confidential under IC 6-1.1-12-37. c"
CERTIFICATION STATEMENT
• I(We) , A L,, 11 C- certify that I(we)occupied as my(our)principal
place of res dance or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
xI
clion is hereby claimed on the date this application is signed,
(date of signature). I(We):
wn. ❑ Am(are)buying under recorded contract
m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
ave 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.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township t` Taxing district(city,town,township)
0�
Parcel num err legal description Is the property in question:
0 Real property Annuallyassessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used uce income,describe the use and portion
\\(� of the property utilized to prZa if come.
I° 1-1 aY • - 0 5 I s -s - 0 0.
` PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes 0 No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberand oh...4dty state,arid liP code) Address of yaw,.hom=stead,if any(number and sheet,city,state,and ZIP code)
310 �_ S. for - ` i— 3-6 ID
ASSESSOR USE ONLY i ASSESSED VALUE HOMESTEAD VALUE 1 NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1)
Other land (2) ` -- '
Total land(final plus line 2) (3)
Residential improvements or Dwelling (4)
a a.
annually assessed mobile/
manufactured home Garage (5) ^'l
5EP 1. 3 tuft
Other improvements (6) <......•....•`-.,1.,__:.__..._...:_:....,r
Total Improvements(line 4 through line 6) (7)
ATotal value(line 3 plus line 7) (8) -��y�
I hereby certify the above is true,correct, Signature of Assessor GIBSON C O U NT 14ai ktl�6�(atmrrit,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE:
20 pay 20 Lesser of 60%of the assessed veiue of the homestead or$45,000. .
Notwithstanding an other."vision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assess='� re roperty or to a manufactured home that is not assessed as real property may
not exceed one-h- t ). the assessed value of the = : .r manufactured home.
Signature ofAuditarAtgiliA lA
J � I Date signed( o�a year) b(
DISTRIBUTION:Original-CauntyAuddor,File-Stamped Copy-Taxpayer
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