Homestead_Jost (3) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
k, STANDARD/SUPPLEMENTAL DEDUCTION HC70
=�_ 1' State Form 5473(R15/55-14)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fhang instnrdipns
NOTE:Telephone,Social Security,driver's license.state identification and federal identification numbers an m,r•- tr.' n• C 6 .- - ,_.
' _ 1,1 1 1.7—-. t _ /^'•`,*:-1.: . `CERTIFICATION STATEMENT,' „Lr r,r. I F.7 ti II s
I(We) /' .�•A• :a certify i a I(w .:u:I-. - - • plir
rincipal
place of dence or am(are)buying the f lowin.described real property under contract for which a Homestead Property Tax Standard
DeduMio Is hereby claimed on the date s application is signed, DRo&ignai2OlGl(We):
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(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 • idence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUNTY AUDITOR
-•
1
Recorders office where corsad is recorded • Record number Page ��
"",r> f r'xyifi ..;IlilROP,ER ,,DESCRIP,TION_.e.
- Carry I Township Tatting daIki(ail:tram township)
Parcel mother Legal desoipton I Is the ry in question:
Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If arty portion of the residential=care or the land not exceedng one(I)acre that ion-ndiatey swards that structure is used to reoduce income.describe the use and pagan
of to Popery(afxed to pod insole.
6 _ Ig- 3 - L/03 - MoD. 6s4-0a s0
Stay County.and Township Is claimant vacatng a homestead?
. ' ❑ Yes ❑ No
Sq a u
I hereby certify the above statements are true,correct,and complete. `mac
as of comata(nubs and tees.City,Kate,and ZIP code) i of -.ed ha.es• . ... (number and Sreer ray,aae,end ZIP code)
2os- 5. Pe l K 5T F4 ffranJL •'i
- ASSESSOR USE ONLY l ' f , ASSESSED VALUE I- . HOMESTEAD VALUE; ,NON-RESIDENTIAL .. .
VALUE
Land not exceeding one(1)acre immediately I(1) :F
surrounding residential Improvements - — ._
Other land (2) -' _.3.._
Total land(line l plus line 2) (3) - - _ -
—
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home
Gaspe (5)
Other improvements (6) - ._ 'en--:-"Z? ....ke 2.r-
Total Improvements(line 4 through line 6) (T)
Total value (line 3 plus line 7) I(8)
I hereby certify the above is true,correct, I Signature of Assessor Date signed(north,day,year)
and complete.
Verdyi g scion-Signature otftrt or Date signed(nice*day.year)
0. -'-7.fS:*D-7F'Itr r--r- ;ArSTANDARD DEDUCT1oNuALLOWANCE'2''_.�?-a,•-`s- ":41- i'-'T•�F 'a
20 pay 20 I ecvr of 60%of the assessed value of the homestead or$45,000
Nohwfthaanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home $
that is rata sled as real property or a manufactured home that is not assessed as real property may
not exceed o all(12)of the assess value of the mobile home or manufactured pane.
Sgramae of /� Date signed(month.day,Year)
DISTRIBUTION:Orgnal-County Arrdtor.Fie-Samped Copy-Tagayer
"o CLAIM FOR HOMESTEAD PROPERTY TAX '-
i�.._2 ? STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 609)
�O � Prewibed by tha Depariment of Local Govemnent Firence
INSTRUCTIONS: See reversa side for fJing instructions.
��
� RM YEAR
C10
JUL 2 4 2009
I(VJe) L certi(y thai I(we�cu ied�5,tµy�r) prindpal
p n
place of re ence or am (are) buyin e following described real property for which a Homestead Pmper�l�6��� ucfion is hereby daimed
under ct on Ihe da[e lhis appli �on is filed, (date of filing):
I(4Ve own ❑ Am (are) buying under recorded conVact
❑ Am (are) enutled ro occupy as a tenant-stockholder of a cooperetive housing corporeGoa
❑ Have a beneficial interest in the Wst or Ihe right to occupy Ihe pmperty under the tertns of a qualified personal residence Wst
of tlaimant (las! !rve d'gifs)
spouse (�u � digds) I Drive/s I'xznse I IdenGfxatirn / ONer number
of daimant's spouu (lasl frve dgrts)
If buying on wntraa, Fee Simple owneYS �uma
Remidefs ofice where mntraG is remrEeG
Counry
Tams�ip
Taring disirict (cily, rown. fownshiP)
Issuin9 �ate
Retad number
Page
i
Parcel num6�([ Legal desaip;1,Jion}L� Is �he property in question:
' g� IJ � 103 �� ��O�`�/ ❑ Real P�oPertY ❑ Mnuatly assessed rtahile home (IC 6t.7-;
If any portion o(the residential swcwre or Ne Ia�M ot exceetlirig me (1) aae �hai immeCiatey surtounds �hat swcWre is used to proAUce income, Cesulbe iha use anC pation
of ihe pmperry uN¢ed 10 P�uce inmme.
��.13-3-II �581�
Ca�my
rwmsntp
I hereby certify ffie above statements are we, correct and complete.
Land
Q
acre immediatey
Otherlantl
Total land (line 1 plus line Z)
Dwelling
Garage
Other improvemenfs
Total improvements (line 4 Nrough line 6j
Total value (line 3 plls 1lne �
I here6y certity the above is true, cortett,
and complete.
Venfyi� arrion - Sgnature ofl�uditw
(�)
(Z)
(3)
(4)
(5)
(6)
(�)
(B)
Sigriature a(ASSessor
ot
20 pay 20 _ Lesser of 60% of the assessed value of lhe homestead or $45.000
NofuiMSlaMing any olherprovison, Ne sum d fhe deGUrlibns provitled in IC 67.1-f 2 to a mo617e home lhat is $
rwt assessed aa real propelly w(o a manufectured home Net a ro( essessed as real ploperry maY �1 esceed -
mehatl(72) W fhe assessetl rdlueW fhe rtpbie fame wmanufartuied hortre.
sig�wre NAWitm
Date signed (month, dey, yea�
Date signed (monN, day, yEa�
,