Homestead_Keil CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ya '4 STANDARD/SUPPLEMENTAL DEDUCTION FORM
• p �)1 State Form 5473(R18/1-20) HC10
•":* 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 underIC 6-1.1-12-37.
CERTIFICATION STATEMENT •SI3fJ "
I(We) Anna Marie Keil certify that I(we)occupied a •. .rinclp
place of residence or am(are)buying the following described real property under: ntract fqr hich a Homes ead Pro.erty Tax Standard
Deduction is hereby claimed on the date this application is signed, /c2-, UI p Q V.,fadate of signature). I(We):
• Own. ❑ Am(are)buying under recorded contract. OZOZ 0 C J O
❑ 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 per
)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
N/A
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township 'Taxing district(city,town,township)
Gibson Haubstadt
Parcel number Legal description Is the property in question:
26-19-31-303-000.196-009 ORIGINAL PLAN 192/193/194 170 Real property 0 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.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes 9] No
Signatur_ fclaimartt
I hereby certify the above statements are true,correct,and complete. /
Address of contact(number and street,city,state,and ZIP code) Address of vacated homeste if,if any if any(number city,state,and ZIP code)
317 S Vine St., Haubstadt, IN 47639
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON- ESIDENTIAL
VALU
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line f plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
P,
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 Dalt s' ed'month, y,y a,)
STANDARD DEDUCTION ALLOWANCE 3
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. DEC 0
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ 2020
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 o Auditor Date sig.t,; th,
GIBSON COUNTY AIJfnITOR
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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