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Homestead_Douglas (12) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR A�,�;;v;;� STANDARD/SUPPLEMENTAL DEDUCTION FORM ' State Form 5473(R17/1-16) HC 10 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) William Bradly Douglas 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, 09/18/2020 (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 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. CLAIMANT'S INFORMATION , ) CONTRACT RECORDED If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number i PROPERTY DESCRIPTION County Township Taxing district(city,town,township) - Gibson Union Union ' p .� 202© Parcel number Legal description Is the property in question: SE? 26-18-23-300-000.173-025 ❑' 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 t se ande I , OR of the property utilized to produce income. .t'C J P G18Sn10 C:0131\1 PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is claimant vacating a homestead? ❑ Yes El No Signature of claims I hereby certify the above statements are true,correct,and complete. a of Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and stre ,city,state,and ZIP code) 2157 W 800 S, Ft. Branch, IN 47648 ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON- ESIDENTIAL VALU 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) , b, /_-11 09/18/2020 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) , •. . 09/18/2020 DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2