Homestead_Hall (2) u"rat, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 4 STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HC10 2019
, Prescribed by the Department of Local Government Finance 4 e
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) Gene 8 Helen Hall certify that I(we)occupied as my(our)principal
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, 10/16/19 (date of signature). I(We):
0 Own. D 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.
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) -
GibsonHaubsta: 1ii. DParcel number Legal description Is the property in question:
26-19-31-304-000.254-009 ®Real property ❑ Annually assessed mobilJ.((roomee(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe thMrfe>tnd Lrt6r i 1
of the property utilized to produce income. ���� L J
GIB • / j."fl71
PROPERTY OWNED ELSEWHERE BY CLAIMANT UDITO
State,County,and Township Is claimant vacating a homestead? R
❑ Yes ® No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. LQ 9/O /�
Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
115 S Third St., Haubstadt, IN
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately 111 ' •
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
ok-S0,1.;, 4,/ 10/16/19
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.
Signature of Auditor Date signed(month,day,year)
,a.,..,,,t ),g.0 10/16/19
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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