Homestead_Tison • ^ 4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y , STANDARD/SUPPLEMENTAL DEDUCTION FORM,
)I,.;
' � State Form 5473(R18 HC10/1-20) 2021
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side fcr 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) Kent J.Tison certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property u r ontract for hich a Homestead Property Tax Standard
-,x
Deduction is hereby claimed on the date this application is signed,(_ �+:�•'f .>-��(} A/� �(daterof signature) I(We):
VI Own. ICI Am(are)buying under recorded contra . (/
❑ Am(are) entitled sto 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.
`�
Recorder's office where contract is recorded Record numbeN 0
47
020
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) GI '�r e_
Gibson Montgomery Montgomery SON Cp0N•• -►
Parcel number Legal description Is the property in question: Ty AUu
26-17-01-403-000.764-021 2 Real property ❑Annually assessed mobile home(IC 64.1=?V
. . 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 the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Indiana,Vanderburgk 0 Yes ElNo
a Slgnatu�'Lu 72
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) Address o vacat homestead,if any(number and street,city,state,and ZIP code)
6957 W North Street,Owensville, IN 47665 2110 W. Deleware Street, Evansville, IN 47712
ASSESSOR'l1SE-ONLY I ASSESSED VALUE I HOMESTEAD VALUE, I:¢r)r 10N-RESIIDENTIAL
Land.not exceeding creep)acre immediately (1)
surroundina residential improvements -
Other land (2)
Total land(line 1 pius 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) (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)
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.
Signal e o Auditor Date signed(month,day,year)
- p
RECEIVE®
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
MAY 0 4 2020