Homestead_Roudebush CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
' State Form 5473(R18/1-20) HC10 2022
lu 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) Jeff&Jill Roudebush certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real propetyundgr contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, II ZZ (date of signature). I(We):
2 Own. ❑ Am(are)buying under recorded contract.
0 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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
Gibson Montgomery Montgomery
Parcel number Legal description Is the property in question:
Q Real property ❑ Annyt�ly.assessed mobs a 54. )
26-10-36-400-003.864-021 PT SE 36 2 12 28.429 AC r`I/m-�f((� soa
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is u�pd t�produce in .,f be the use an n
of the property ofil ead to produce income. "lam V 2022
Op+
PROPERTY OWNED ELSEWHERE BY CLAIMANT _
State,County,and Township Is claimant vacatinfDV.. '--d?
Li Yes No R
"re
• A A
I hereby certify the above statements are true,correct,and complete. o -./ +t, JMrJ
Address of contact(number and street.city,state,and ZIP code) homestead,if any(number and street.city,state,and ZIP code)
6760 W 450 S,Owensville,IN 47665 VVV
VALUE HOMESTEAD VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding reaidentiai lmp•'c-rarnanta
Other land (2)Total land tans 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (5)
Signature of Assessor Date signed(month.day,year)
1 hereby certify the above Is true,correct,
and complete.
Date signed(month,day.year)
Verifying action-Signature of Auditor
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.
• Date signed(month,day,year)
Signature of Auditor u —t�`Zp 7
DISTRIBU N.Origin Auditor,File-Stamped -Taxpayer r�` —1
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