Homestead_Mason (8) 40-.4, CLAIM FOR HOMESTEAD PROPERTY X YEAR
��I STANDARD/SUPPLEMENTAL DEDUCTION FORM
-/' State Form 5473(R15/1-20) HC70 2020
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) Scott L&Jacklyn S Mason 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, (date of signature). I(We):
ICJ 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 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.
CONTRACT RECORDED
If 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 Ft. Branch Ft. Branch
Parcel number Legal description Is the property in question: r r� 20
26-19-19-204-001.329-026 I N DIAN HILLS 85 Ikl Real property ❑Annually assessed mo e( 6-1.1
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.
4244.cliztr-----.
GIBSON COUNTY AUDITOR
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,county,and Township Is claimant vacating a homestead?
❑ Yes No
Signat e of claimant I hereby certify the above statements are true,correct,and complete. !f_ t-
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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)
423 E 795 S, Fort Branch, IN 47648
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
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) ?, , '":1';,,' ,
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 S45,000.
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 a essed value of the mobile home or manufactured home.
SignaUre of Auditor Date signed(month,day,year)
1,,,`s t1� —�)\;_ wit- - jki8i--3- q -1-XPrO
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Tayer
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