Homestead_Humphrey (2) CLAIM FOR HOMESTEAD PROPERTY TAX t FORM YEAR
�4 STANDARD/SUPPLEMENTAL DEDUCTION OR 2021
Stale Form 5473(R18/1-20)
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) Holly Humphrey 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, c -g - o�0 l _ (date of signature). I(We): ,
6T4 Own. D 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
Name of claimant(legal name)
Social Security number of claimant's spouse(last five digits) Driver's license/Identification I Other number of claimant's spouse(last five digits) Iss State
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name • �VVJ
• o
Recorder'sRecord rtrytZ Page
once where contract is recorded 2042/
SQ41Ca 12 . ..
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) 0/7-
Gibson Princeton Gibson, Princeton OR
Parcel number Legal description Is the properly in question:
26-12-07-202-002.141-028 PT NE 7-2-10.25 AC 171 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 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? J
Indiana, Gibson, Princeton Yes ❑ No
Si natu o lai n
I hereby certify the above statements are true,correct,and complete.
W
Address of contact(number and street,city,state,and ZIP code) Address of vacated h es ead,if any(number nd street,city t te,and ZIP code)
820 E Oak St., Princeton, IN 47670 727 S Main t., Princeton, IN 47670
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON- ESIDENTIALVAL 0
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
0
Other land (2)
Total land(line 1 plus line 2) (3) p0
Residential improvements or Dwelling (4) .• I
annually assessed mobile/
manufactured home Garage (5) Q
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)
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)
\j(N(NL6Aa&-' CL- a.--,‘- -43 ilf\'?S C9 'aC)C1
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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