Homestead_Will (7) See ` CLAIM FOR HOMESTEAD PROPERTY TAX M YEAR
STANDARD / SUPPLEMENTAL DEDUCTION
E
`', State Form 5473(R17/1-16) g
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. NOV 7 2018
NOTE:Telephone, Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
•.L'pjtr vn.
I(We) Jennifer L Will certify thaalta&D;iipoettrgRenytklriekicIPal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 11/7/2018 (date of signature). I (We):
lti Own. ❑ 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.
❑ Am (are) the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Johnson Haubstadt
Parcel number Legal description • Is the property in question:
26-19-31-301-000.409-009 C✓J Real property ❑ Annually h•,r - .c6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce hips.d - -:escribe ' .portion
of the property utilized to produce income. v VV 7
20/8
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a hod stead?
Indiana, Gibson, Johnson [✓ Yes ❑ No
Signature of claimant n
I hereby certify the above statements are true,correct, and complete. ,iI4/1t/V 1
Address of contact(number and street,city,state,and ZIP code) ress of vacated ho estead,if any(number and street.city,state,and ZIP code)
311 N. Vine St, Haubstadt, IN 47639. 10430 S Hunters Crossing Dr, Haubstadt, IN 47639
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-R/ESISIDENTIAL
UE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
•
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage I(5)
Other improvements (6)