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Homestead_Greenwell - s ►.' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD / SUPPLEMENTAL DEDUCTION H Ro 2021 � State Form 5473(R18/1-20) '4 , -.?" 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/C 6-1.1-12-37. CERTIFICATION STATEMENT I(We) Greenwell, Richard E/Janet A 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, 01/01/2022 (date of signature). I (We): ® Own. Li 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 If buying on contract,Fee Simple owner's name Record number Page Recorder's office where contract is recorded PROPERTY DESCRIPTION County Township Taxing district(city,town,township) Gibson Johnson Haubstadt, Parcel number Legal description Is the property in question: 26-23-16-200-002.720-024 Ridge Manor Estate Sec 2, Lot 8 © Real property ❑ Annually assessed mobile home(/C 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. 26-23-16-200-002.720-024 PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is claimant vacating a homestead? ❑ Yes ❑✓ No Signature of claimant�,. "----." - - 4 ""` . I hereby certify the above statements are true, correct, and complete. 6e �-�, / —e Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code) 2468 E Classic Dr, Haubstadt, IN 47639 NON-RESIDENTIAL ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VALUE Land not exceeding one(1)acre immediately (1) . surrounding residential improvements Other land (2) F 1 ,,-,, Total land(line 1 plus line 2) (3) i■ Residential improvements or Dwelling (4) 2ULC annually assessed mobile/ JAN 01 manufactured home Garage (5) Other improvements p COUNTY AUDITOR Total improvements(line 4 through line 6) (7) Total value (line 3 plus line 7) (8) GIBSO Signature of Assessor Date signed(month,day,year) I hereby certify the above is true,correct, and complete. Date signed(month,day,year) Verifying action-Signature of Auditor 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 Auditorr Date signed(month,day,year) 1 , , l �. IV`/1YI-S (` 01/01/2022 DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2