Homestead_Pfettscher ire CLAIM FOR HOMESTEAD PROPERTY TAX ( FORM I YEAR I
\y STANDARD I SUPPLEMENTAL DEDUCTION HC70
d�y��S/+ State Form 5473(R1811.21))
ur,
' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification
tRTIn CATION STA(TEMENTnumbers am confidential under IC 6-1.1-12-37.
Kod PfettSChef certify that I(we)occupied as my(our)principal
I(We) described real property under contract for which a Homestead Property Tax Standard
place of residence or am(are)buying the following (date of signature). I(We):
Deduction is hereby claimed on the date this application IS signed,
IZ Own. ❑ Am(are)buying under recorded contract. corporation.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing P
❑ Have a beneficial interest in the trust or the right to occupy the propertythe under the terms of a qualified personal residence trust.
❑
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CONTRACT RECORDED
If buying on contract,Fee Simple owners name
N/A
Recorders office where contract is recorded
Record number Page
County PROPERTY DESCRIPTION
Township Taxing district(city,town,township)
Gibson �,•
Montgomery Montgomery Parcel number Legal description , 'y,
26-17-03-100-705.560-021 Is the property in question:
BLDG ON LSD GRD h Realproperty ❑v� II assesses
of any proper of the resin prod)strce inco eor the land not exceeding one(I)acre that immediately surrounds that structure is used to produce no.,a,describe the hoAti•'on.�
the property utilized to produce income.
State,County,end Township PROPERTY OWNED ELSEWHERE BY CLAIMANT Gi • `�/
Indiana, Gibson, Montgomery Is claiman ring a homestead?
I hereby certify the above statements are true,correct,and complete. 0 Yes -
(t Signatures!
Address of contact(number and street,city,state,and Z/P code) -' � �
9267 W 450 S, ��/
Owensville, IN Addre of va ,:d(iomast ad,if any(number and street,cry,state,and ZIP code)
47665
w ASSESSOR USE ONLY
Land not n.re identine-(1),acre immediately -I ..:ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
surroundin.residentialim•rovements +
Other land
Total land(//ne f - _.--� , .,, ,:
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P/us/me 2) .--
Reside _•�---
ntial!
annuallY assmPrOvernantsor _
manufactured home• °bile/ Dwe111ng _
Other/mProvernenLs •__.....
TotallmProvernents �-
Toral value (/lue 3 (/ine 4 through//ne 6)Phis )
end cbYpert /ine7)
col' the above
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Signature
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