Homestead_Washburn •
,,'—�'4 CLAIM FOR HOMESTEAD PROPERTY TAX
= /// STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR
•,, u� State Form 5473(R19/1-23) HC10 7p2`t
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.
�1 CERTIFICATION STATEMENT
I(We) • 'v r re�^• certify that I(we)occupied as my(our)principal place of
residence or`n :re)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
this application is signed. (date of signature).I(We):
Own. ❑Am(are)buying under recorded contract.
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have 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.
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County t _ Township O ^ Taxing District(city,town,township)
liJ
Parcel Number Legal Description I he roperty in question.
al Property 0 Annually 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 sue nds t t structure is used to produce income.describe the use and portion
of the property utilized to produce income.
2 C - 1 0 - 2 �=moo-- o 0 li L, 0 2- u2_1
PROPERTY OWNED ELSEWHERE BY CLAIMANT ,•
State,County.and Township Claimant Vacating Homestead? W\
C.)
es No v
I hereby certify the above statements are true,correct,and complete.
X Si
gnat on
Address of Contact(number aka st:.=t,city,state,and ZIPO % —� Ad. 'ss of V ca Homestead,it any(number and street,city.state,and ZIP code)
ZZ(`t 2 5 6 cic iv l e
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3) FILED
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
JU_ 12 2024
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) _'L 1
Total Value(Line 3 plus Line 7) (8) �""-`
GIBBON rnuNTY 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 S48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ _1/�J�
is not assessed as realproperty or to a manufactured (is t assessed as real property may rat ` / 'r
exceed one-half(1/2)of the assessed value of the bit me r ma factured v
Signature utlitRr ,, Date Sh�e�/mm )year �2 - �\�
illy (� Al `
DISTRIBUTION: Original-County Auditor,File-Stampe opy-Ta er
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