Homestead_Elpers (18) ^��4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a .I STANDARD I SUPPLEMENTAL DEDUCTION FORM
Yr. '-r State Form 5473(R18/1-20) HC10
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) Carolyn S. Elpers certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real zoperty under co tract-for-which/,'(�.Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signedf Q �� c�.0.(zV (date of signature)]I(We):
l l Own. El Am(are)buying under recor 7d 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.
- . __ __ __ __
w CONTRACT RECORDED. ,; _ ',,,,
It buying on contract,Fee Simple owner's name _.._ _ --
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Haubstadt Haubstadt, Haubstadt, Haubstadt
Parcel number Legal description Is the property in question:
.6),
26-19-31-400-000.759-009 BRIARWOOD SUB DIV II LOT 45(.434 AC) CO Real property ❑ Annually assessed mobile home(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 the use 414rtio0.
of the property utilized to produce income.
2p
G/ ' .' �0
es •
PROPERTY OWNED ELSEWHERE BY CLAIMANT ''VY •/
State,county,and Township Is claimant vacating a homestead? 1- ":
Yes IDNo Q/?, •
l Signature of claiman J ii O•?
I hereby certify the above statements are true,correct,and complete. J J(
r•
Address of contact(number and street,city,state,and ZIP code) Address of vacated ho teach if any(numberan street,city,state,and ZIP code)
703 Edinborough Ct., Haubstadt, IN 432 S.West St, Haubstadt, IN
ASSESSOR'USE ONLY . ',J ASSESSED VALUE �F--. HOMESTEAD VALUE NON-RESIDENTIAL
...,:.. :. F., _«.. - -..:.-��----..ram->..--•.-t;:
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 (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.
Signature of Auditor Dale signed(month,day,year)
I -b.2
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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