Homestead_Manning "Alt. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
2.1 STANDARD/SUPPLEMENTAL DEDUCTION HC10 �laZ
�F State 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) "st. \a 6 1\VY, certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the follow j described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
Own ❑ Am(are)buying under recorded contract.
m (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
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
County Township r Taxing district(city town.township)
Parcel number O Legal description Is t e perty in question:
Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surro ds t at structure is used to produce Income,describe the use and portion
o/the property utilized to produce income Q r SS7 — V
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township - Is CI@iglbnt vacating a homestead?
Yes ❑ No
Signatur=of de'.ant ^
I hereby certify the above statements are true,correct,and complete. i
Address of contact(^umpe r and street,crate.and ZIP code) /f.dress of heTWeed.if any(number a t.city, .gt`.^`QZIP code)
22l N 8)"O C w - \C't[VAc�r _-n . `YI•h1- 11\e- 66 S
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately ✓sue
surrounding residential rmprovements (1) WW-
Other land (2) - `'?."r'"'
Total land(line 1 plus line 2) (3) . ■
Residential improvements or Hpwelling (4)annually assessed mobile/manufactured home arage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (7) -
Totai value (line 3 plus line 7) Sig L a
1 hereby certify the above is true,correct,
Signature orAsaesso� AUDITOR Date signed(month,day year)
and complete. GIBBON COUNT
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 lC 6-1.1-12 to a mobile home S
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 i e or manufactured home.
Signature of Auditor (Del Date sign m n .day 24...
DISTRIBUTION: Original-County Auditor-File-Stamped Copy-Ts
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