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Homestead_Obert (9) rpr CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 1 STANDARD I SUPPLEMENTAL DEDUCTION FORM Nhp) State Form 5473(R17l 1-15) HC10 l J Prescribed by me Department of Local Government Finance INSTRUCTIONS:See reverse side for filing ins;rucmns NOTE:Telephone,Social Secunty,dnver's license,state iden.5cation and federal ioentb.Scaton numbers are con.5denbal under IC 6-1.1-12-37. I(We) MamSW G.own certify that I(we)occupi '(o I pri 1)1 ,'. place of residence or am(are)buying the following described real property under contract for which a Homestea• - T. ..- - . Deduction is hereby claimed on the date this application is signed, 71.26&7019 (date of signature),I I(We):q (� E) Own. 0 Am(are)buying under recorded contract. JUL 2 6 2019 ❑ 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. I ej �sflI7Th _ I- rY ."• ' '!.'. 0'.; CLAIMANTS INFORMATIONeT- ru "y'"1S M'-tr.i •.i •UD OR Name ofWimant fie al name) Telephone i!w7T s Social Secumy number of claimant's spouse(last the does) Driver's license/IdenG'ration/Other number of claimant's spouse(last Pm dgts) Issuing State (ApWcaale only of applicants spouse dues not have a social securay number) _ P CONTRACT RECORDED'.?, ^�< . y.y'- _ - If toying on contact.Fee Simple owners name Recorders oSce where contract is recorded Record number 1 Page - c... ....; '. . -, 1 .. .t..�-.._-il, .,, !PRO - N DESCRIP,TION.:G„P...o ♦ Sel= ?II'. t c,.. .. + .. County Twmstp Taxing district(cry.town,mhenshup) gibson Union Union Twnshp Parcel number Legal description is the property N pueswn: 26-19-13-200-000.778-025 C Real popery 0 Annually assessed noose home(IC&Lt.7) If any portion of the resbental stumre or the land not e.eeedeg one(1)acre that immediately surrounds that structure is used to produce income,desmbe the use and porton of the property utilized to produce S,wee. ` ' . .;' ..:,? _PROPERTY OWNED ELSEWHERE BY CLAIMANT t kf.g:;"_ . •r _ ' ... .. Stye.County.and 0 Yes o No Signature of elavwnt �> I hereby certify the above statements are true,correct,and complete. 1 1 /.?/TCZ- Address of contact(number and street.cry,State,and ZIP code) Address of vacated homestead.if any(number and street,cly state,and ZIP code) 5049 E 750 S, Ft. Branch, IN 47648 5156 E SR 168, Ft. Branch 'ASSESSOR USEONLY(),..-I.. 'I ?.ASSESSED VALUE. I It HOMESTEADVALUE lI Q''x NON yES1UENTAL'^ Land not exceeding one(1)acre immediately (t) surrounding residential improvements Other land (2) , - Total land(line 1 plus line 2) (3) Residential improvements or Dwelling (a) annually assessed mobile/ manufactured home Garage (5) Other improvements (6) Total Improvements(line 4 through line 6) (7) Total value (line 3 pita line 7) (8) I I hereby certify the above is true,correct. SipulYre of Assessor Date signed(nhor h,day yee0 and complete. Rallying anidht-sgnar:re of Audtpr 7/26/19 .day tea.) r ry . ., _. - - STANDARD DEDUCTION ALLOWANCE. - f " 20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000. Namthstndirg any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(12)of the assessed value of the mobile home or manufacture('home. Sigtasre of Auditor Date signed(month,day year) y,:rry 5.., , ,t_ 7/26/2019 oesnomutiON:Ongnal-County Amides.Fie-Santeed Copy-Taxpayer Page 1 of 2