Homestead_Shreffler CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
,,�,,,/ STANDARD I SUPPLEMENTAL DEDUCTION HC1e 2022
�-, 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) Kelli&Brian Shreffler 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, 6/13/2022 (date of signature). I(We):
2 Own. ❑ 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.
LI 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 owner's name Le_41161rn
Recorders office where contract is recorded Page
PROPERTY DESCRIPTION
County Township Taxi - .trict(city town,townsh' '22
Gibson Haubstadt 49
• '-
Parcel number Legal description O. r. Vu9it5�
26-18-36-404-000.165-009 PT SE 36 3 11 .38 AC I (T-e1;/4WP;yL/!/^ Annually assessed mobile home(/C 6-1.1-7)
I/any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is
income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,end Township Is claimant vacating a homestead?
na a
❑ Yes [ No
y py1a y yla j l
I hereby certify the above statements are true,correct,and complete. /
Address of contact(number end street,city,state,and ZIP code) Address of vacated homestead,if any( �
d street,city,state,and ZIP code)
511 W SR 68,Haubstadt,IN 47639 604 E Washington St,Ashkum,IL 60911
ASSESSOR USE ONLY ASSESSED VAI UE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements Other land (2)3) F j�,E
Total land(line 1 plus line 2) (
Residential Improvements or I Dwelling (4) -
annually assessed mobile/ ,
manufactured home Garage (5) , UN
Other Improvements 64) 13 2022
Total improvements(line 4 through line 6) 4>�)/jJ
Total value (line 3 plus line 7) -(�p Sg g�,.�_�"'_��/�
,./��
signature of Ass2rs861VTY —" rs� Date signed(month,day,year)
1 hereby plete. the above Is true,correct, ALi0/
and complete. TOR
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)
• I
DISTRIBU N:Original-County Auditor.File-Stamped Copy-Taxpayer
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