Homestead_Cline PERTY
STANDARD/SUPPLEMENTALO ED C FORM
TION YEAR
r-T, CLAIM FOR HOMESTEAD TAX
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3\* 1 State Form 5473(R18/1-20) HC10 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) Donna Faye Cline 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, 1 1/17/2020 (date of signature). I(We):
2 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) T.
bS e
Gibson Princeton Princeton
Parcel number Legal description Is the property in question: 70
26-11-12-204-003.147-028 EMBREE EN LG 18 I70 Real property ❑ Annually as'Ale l ome(IC
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 po
of the property utilized to produce income.
•
GO-
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Indiana, Gibson, Princeton ❑ Yes VI No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. rO ivM0. Cl p •
Q
Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(n er and street,•city,state,and ZIP code)
110 N. Center St., Princeton, IN
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON- ESIDENTIAL
VALU
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)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above i5 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 va of the mobile home or ma ufactured home.
Signatur of Auditor Date signed(month,day,yea
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer ri(g(i° 1 n 0 a()
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