Homestead_Schaefer (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 STANDARD/SUPPLEMENTAL DEDUCTION FORM 22.
ClI State Form 5473(R18/1-20) HC,O
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.
I(We 1 MVO/X.Ce_ 01 alk. certify that I(we)occupied as my(our)principal
place of residence or am(are)b g the following d ribed real property ll?d4y,oy&Ce t f9r`Nhich a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, L_�l (1/ry " (date of signature). I(We):
XO Elwn. Am(are)buying under recorded trac.
m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ ave 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.
(Applicable y ifpo
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County Township r r Taxing district(city.town,toyigship(
� Fd- 4'-o-^ • U
Parcel number Legal description Is I operty in question:
Real property El 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 surr ds th t structure is used to produce income,describe the use and portion
of the property utilized to produce income. 0�` /�1�'1 /7 �a-
PROPERTY OWNED ELSEWHERE BY CLAIMA N7 r
State,County,and Township T! �a homestead?
� IA;p4..
No
Signal -of claimant 1
I hereby certify the above statements are true,correct,and complet A' et / . ,
� , Add-s of vacs d homestead,if any mber and street,city.state.and ZIP code)
Aalip
1.°
`' .. .`.ram3 ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE
Land not exceeding one(1)acre immediately (1) '_ ".
surrounding residential improvements - - ..
t
3' Other land (2)
\ Residential improvementsTotal land(line 1 plus line 2) (3) -`_
or Dwelling (4) ■ �.•
annually assessed mobile/
manufactured home Garage (5)
\\ 1./' Other improvements
Improvements fl'1,S'\Y/t Total improvements(line 4 through line 6) (7) APR 0 6 2022
,\ Il . Total value (fine 3 plusline 7) (8)
�` {/ Signature of Assessor �����t_ //'1� Date signed(month,day.year)
Ir7) �� 1 hereby certify the above is true,correct, ✓Jug-LAG__C/
and complete.
` _ GIBSON COUNTY AUDITOR 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 dod Lions provided in/C 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manure re me that is not assessed as real property may
riot exceed onekA
-hha/f(1/2)of assess value of a mobi horn r manufactured home. ,
Signature of Audit 4-V Djgn d onth da>rfWear) ^ l
DISTRIBUTION: Original-County Auditor.File Stamped y-Tampa /U^/v\C//I L.
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