Homestead_Hollen "z•, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1 ' STANDARD/SUPPLEMENTAL DEDUCTION FORM ���
1 State Form 5473(R19/1-23) HC 10
�., 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 confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) S� ♦ , P.L t certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the lIoo�'i I roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
Atisapplication is signed,
this _ (date of signature).I(We):
n. ❑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 qualified personal residence trust.
❑
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County .. Taxing District(city,town,township)
U3so'
Parcel Number Legal Description th property in question:
Real Property ❑Amualty Assessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately su un s that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26e-12— CI t..0\ — D 01 . 701..---- 02Z '
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is Claimant Vacat,g:Homestead?
❑Yes IP No
Si nature o1 Claimant �
I hereby certify the above statements are true,correct,and complete. �//%/�
Qi a
Address of Contact(number and reel, ly,state. IP code) d7 of Vacated Homestead.if any(number and street.city.state,and ZIP code)
•
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) F��E
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) JUN N
vv 0 5 2024
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) -n/'41-/ 2. * s
Total Value(Line 3plus Line 7) (8) GIBSON COUNTY AUDITOR
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete.
Venfying Action-Signature of Auditor Date Signed(date,month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided an 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-hail(la)of the assessed value of t ile home or manufactured home.
Signature o udilor Date Sign1,r1,76,...2,k4
DISTRIBUTION: Onginal-County Auditor,File-Stampe opy-Taxpayer
Page 1 of 2
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FORM HC 10 1979