Homestead_Purkiser (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
HC10 ' 1
State Form 5473(Rt6/1-20) �^,2
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing Instructions.
NOTE.'Telephone,Social Security,driver's license,state identifcation and federal identification numbers are confidential under IC 6-1.1-12-37.
�i CERTIFICATION STATEMENT
I(We) •!_ '_• • / /, — -. certify that I(we)occupied as my(o pr nc <I Lif
place of residence or am(ard. ying the following described real property under contract for which a Homestead Property Tax Ste
Deduction is hereby claime. n the date this application is signed, _ (date of signature). I(We):
Nov _1_7)
tEO . ❑ m(are)buying under recorded contract.
Am wn(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 8 202/
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified perso.- .-sidence 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 owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
• Township T.xil ict(city inn,towns
40.
nl number /,�Q�n�descriptio/n�' -/ /� 5ef3Re:
in question:
`\� // ��inn _ ,may Ioperty ❑ Annuallymobilehome(IC6-11-7)If a rti of the residentiJia/: that structure is usetl to produce income,tlescribe the use and portion
of rty utilized to produce income. /
afe, - -C-/OO- 000. 'O ' --00/
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature f claimant
I hereby certify the above statements are true,correct,and complete. '
rAddrass of wntact(number and street,cky,state, d ZIP code) ddrass of vacated homestead ny(number and street,city,state.and ZIP code)
4- - 5 S
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)- _. °f^'°7` °`^r=''� •"^" `
Other land (2) r
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) "$ re TT'
manufactured home Garage (5)
s
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pIts line 7) (8)
1 hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Da[a signed(month.day.year)
STANDARD DEDUCTION ALLOWANCE
.ttiiiiiti► fir.
20 pay 20 Lesser of 60%of the:sassed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of th deductions provided in IC 6-1.1-12 to a mobile home $ O
V that is not assessed as real property or to a man factures home fhat is not assessed as real property may 18 2021
not exceed one-half(1/2)of the assessed valu of the mobile home or manufactured home.
Signafur f •itor Daate,/igned(mon�fth dday,year)
(\` L 4!� / fie.�. ..�.i -. __. .�...rF!{.G! ..14
DISTRIaUT ON:Original-County Autlitnq File-Stomped Copy-Taxpayer G I B S O N COUNTY AUDITOR --
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