Homestead_Martin (13) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
v1,, STANDARD/SUPPLEMENTAL DEDUCTION FORM
NC:, State Form 5473(R18/1-20) HC10 o'ZQ
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Prescribed by the Department of Local Government Finance 1�Os '�c� `
INSTRUCTIONS:See reverse side for filing instructions.��
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NOTE:Telephone,Social Security,driver's license,state identificatiorf and federal identification numbers are confidential under IC 6-1.1-12-37.
ClE�RTIFICATION STATEMENT
I(We) 11'k i'`'f ) Y - certify that I(we)occupied as my(our)principal
place of residence or (are)buying the followin• described real property under contract for which a Homestead Property Tax Standard
ODedction is hereby claimed on the date this application is signed, (date of signature). I(We):
wn.. ❑ Am(are)buying under recorded contract •
✓�✓✓❑ m(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.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County r Township Taxing district(city,town,township)
s 0 28 0�g .
Parcel number Legal description Is the roperty 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 surrou s t at 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 cl i ant vacating a homestead?
Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. 7n
Address of contact(number and street,city,state,and ZIP code) Address o homestead,if an (number and isireft,city,state,and ZIP code)
423" . , - e vc. 11° L'q-6 90
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIIDENTIAL
VAL
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) pi
PI
annuallyassessed mobile I l y _4`a f
manufactured home Garage (5) ,• , .
Other improvements (6) SEP 2a2
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) -----
Signature of Assessor .7 + Date signed(month,day,year) C.n
I hereby certify the above is true,correct, a?S 1
and complete. GIBSON COUNTY 1-,;,;ems'"Cr �l
Verifying action-Signature of Auditor bate signed(month,day,year) •" 0
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STANDARD DEDUCTION ALLOWANCE
O r':)
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. coo
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 rea perty or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2) •'essed value of the mob'- . e• •anufactured home.
Signature of Auditor , Date si nec month,1a ar)
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DISTRIBUTION:Original-County Auditor,File-Stamped Copy Taxpayer 1 t
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