Mobile Home_Davis (3) ` e i
CLAIMFORHOMESTEAD PROPERTY TAX YEARy° STANDARD I SUPPLEMENTAL DEDUCTION CRoi' /1 State Form 5473(Rid/1-20) a3
Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions I
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1 1-12-37. M�/_•1
CERTIFICATION STATEMENT "• ��j►rJ
I(We) W \V btiik 0\-V LS certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard �n
Deduction is hereby claimed on the date this application is signed. 6/eP 6,2 T. (date of signature) I(We) t7 1 1
(]/Own. ❑ Am(are)buying under recorded contract.
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. `
EHave 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.
• CLAIMANT'S INFORMATION . ..
!If buying on contract Fee Simple owner's name
1
---Recorder's office where contract is recorded Renard nambe- page
PROPERTY DESCRIP710N
County Township 1 Tax!ng district(city town,township)
(.7*�Sor 1
c-wKe-toh
IParcel number 1 Legal descrptcr Is the property in question
— (3D ❑Rea!property Annually assessed mobile home(IC 6-1 1-7)
If any parson of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure's used to produce recarre describe the use and portion
of the property utilized to produce income
nu -L\ ag - cr---,a -co
PROPERTY OWNED ELSEWHERE BY CLAIMANT
I State County and Township Is claimant vacating a homestead?
❑ Yes ❑ No
~ TSignature of dai ntt. 1
I hereby certify the above statements are true correct,and complete
1 Address of ce^'a:• -_tuber and street city stale and ZIP cadet Address of vacated-homestead if any(number and street city state and ZIP cede)
6o 0 c r- ., .5*- M—S
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surroundin•residential im•rovements _
Other land I(2) ,
Total land(line 1 plus line 2) 1(3) I
Residential improvements or Dwelling (4)
annually assessed mobile I (5) MAY 2 6 ZOZ3 manufactured home Garage 4 ‘,/
Other improvements I(6)
Total improvements(line 4 through line 6) (7) _ / /I a_ .L/ici..�itCtpJ
Total value (line 3 plus line 7) 1(6) GIBSON COUNTY AUDITOR
I
hereby certify the above is true,correct Signature orpssessar pate signed(month day year)
and complete.
Verifyingaction-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 I Date signed(month,day.year)
' •ram j S/ 4/°'3__ t
DISTRIBUTION: Original-County Auditor File-Stamped Copy-Taxpayer
Page 1 of 2 \
4. MANUFACTURED (MOBILE) HOME PERMIT
i"ttil;%: ' ' - = " ' - ' - - T - ORIGINAL
__i________s±i:__:.i,__,_ ,„, ,,._,. _ x ....,,,:,.. ,_ _ ___„_, , -7 . , ..- -H F-.-- c- ::---., r 7 r_.' = 7 -_ = = _.: - .7 " . 1.--7 -•:- T - -7:--;.7-,
NOTE - __. _ .. �=--
ATTENTIO`+. MOVER HAULER OR TOWER
SECTION A A. MOVING PERMIT
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