Homestead_Gunderman ter, CLAIM FOR HOMESTEAD PROPERTY TAX FORM� YEAR
\ rj STANDARD/SUPPLEMENTAL DEDUCTION FOR ZO?,o
State Form 5473(R17/1-16)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for BEng instrucffons.
NOTE:Telephone,Social Security,driver's license,state identification and federalidenfdicaffon numbers are confidential under IC 6-1.1-12-37.
c CERTIFICATION STATEMENT
I(We) SIOfP_ 1 �� • certify that I(we)occupied as my(our)principal
place of residence or am(are)b 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, (date of signature). I(We):
❑ 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 light 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.
Social Security number of claimant's spouse(last five digits) Driver' e tt71t e5—nu r 4 claimants spouse(fast five digits - Issuing State
(Apprrcable only lfappli ant's spouse does not harm a social security number.)
I . t
CONTRACT RL;;ORDEC
If buying on contract,Fee Simple owner's name
.1*417
Recorder's office where contract is recorded .; Record number Page
GIBSON COUNTY AUDITOR
PROPERTY DESCRIPTION
County - ^ Townships 1—\� ^A ^ Taxing district(city,town,township)
�J 1 •
mv 1 �
Parcelnwn Legal desrrip8o Is the property in question:
❑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 and portion
of the property utilized to produce income.
LIoO--ook . _O21 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Yes No
Sign Octalrtiagt
I hereby certify the above statements are true,correct,and complete
Address of contact(numberand alert city,,stale,end ZIP code) Address of vacated homestead,Warty(number end street,dty,Mare,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON- ESIDENTIAL
VAL
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 Garr (5) .; ..
Other improvements (6) :....:............
Total improvements(line 4 through line 6) (7)
Total value(fine 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 o r p vi on,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as al erty or to a anufactured home that is not assessed as real property may
not exceed one-half(1/2 of e ssess the mobile ma aired home.
Signature of Auditor ^n Da e (rpontnth, yyea4
),01.6
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer
Page 1 of 2