Mobile Home_Collins (4) a
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORMO
State Form 5473(R18/1-20)
\ � 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 identification numbers are • fir:nt u 'r IC 6 2 II
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CEPTIFICATION STATEMENT Cb
I(We) �j /YL4— certify that I(we)occupied as my(our)principal \.._)\(
.p
place of residence or am(are)buying the following described real property under contract for which a es a P Tax Standard
Deduction is hereby claimed on the date this application is signed, Nate dtsank� I(We):
❑ Own. ❑ Am(are)buying under recorded contract. t.ffiC
E Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corpdrryEipn I,
El Have a beneficial interest in the trust or the right to occupy the property under the to I 1�Ce trust.
E Am (are)the shareholder, partner, or member of the entity that owns the property.GIBSON COUNTY AUDITOR
CLAIMANT'S INFORMATION
)
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County O Township O \� Taxing distil (city.town,township)
.rcel number -. descnption r/ 9 p Is the property in qu on:
/_- yl 7- b 56 / 8, d v' / A.,y,A.. ❑Real property nnually assessed mobile home(IC 6-I 1-7)
10 v 1
. •.. ion of the - id•• truct -• - .nd not exceeding one '/acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the prope u i ized to produce income.
07& • OA —.27 - /P0 -000, iO3 -0/ 7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
•nature of cl 'merit
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) Ad OresS of vacated homestead,if any(number and street,city,state,and ZIP code)
'Z4 — f -
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
V Total land(line 1 plus line 2) (3)
,�`ram+ Residential improvements or Dwelling (4)
1 v annually assessed mobile/
manufactured home Garage (5)
Other Improvements (6)
, .k.....
Total Improvements(line 4 through line 6) (7)
,..(3,\ Total value (line 3 phm line 7) (8)
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,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor n� / Date signed(month,day year)/
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer ��
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