Homestead_Rodriguez CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A' ��STANDARD/SUPPLEMENTAL DEDUCTION n C�
`r HOW0`1
�� =sq�• State Forth 5473(R17/.1-18)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identifical on numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) 1 Ora P (KY "\ 1 certify that I(we)occupied as my(our)principal
place of residence. (- e)buying the following describ' I prp , under contract for which a Homestead Property Tax Standard
eduction is hereby claimed on the date this application is signed, lJ Own. El Am(are)buying under recorded contract
❑ m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. (date of signature). i(We):
❑ 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
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County /\ Township ^�� ' ,Taring district(city,town,township)
3
Parcel number Legal descrip on is the property in question:
Real property 0 Annually assessed mobile home(/C 6-r.l-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
.� 2—IS 4o2- tou . 24T-02..-3- ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is claimant vacating a homestead?
❑ Yes ❑No L •
(claimant p�
I hereby certify the above statements are true,correct,and complete. VANct., -`y� irti
Address of contact(numberend sheet;city,stele,and ZIP code) ddress of vacated horn(� mberand-.-_ ' state, ZIP code)
ASSESSOR USE ONLY j ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(I)acre immediately 74 M
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3) .
Residential improvements or Dwelling (4) • fl
annually assessed mobile 1 DEC
�$
manufactured home Garage (5) D C C ;U L.0 1 • .
Other improvements (6) •{Any'
Total improvements(line 4 through fine 6) (7) 0
Total value(line 3 plus line 7) (8) GIBSON COUNTY AUDITOR
I hereby certify the above is true,correct, Signature of Assessor Date signed(month day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day, ,ar)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any( rovi the sum of the deductions provided in iC 6-1.1-12 to a mobile home $
that is not assessed-iiii,pro•- orb a manufactured home that is Trot assessed as real property may
not exceed one-half 1 Ur.- sessed value the mobile home or c d home.
Signature of Auditor Date mom'',dam a�� .
DISTRIBUTION:Original-Co �fr •,File-Stamped Copy-Taxpayer
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