Homestead_Vidal i
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM 1
STANDARD!SUPPLEMENTAL DEDUCTION IL HC10
State Form 5473(R18/1-20)
0
}CPrescribed 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) r . • s certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract or which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 4/2 8/a-a (date of signature). I(We):
R/wn El Am(are)buying under recorded contract.
El Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El 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.
CLAIMANTS INFORMATION
PROPERTY DESCRIPTION ,E D
County Township Taxing district(city.town.township)
GIbso1� -- • U \ &s.
Parcel number / Legal description I Is the property in question.
94-C-tg-Li0a—Ocr). ocil
/)D—
r / i eel property ❑ Annually assessed mobile home(1C QO YN) 2 8 2022
If any portion of Me 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
�l `/
of the property utilized to produce income ./�/,Yf
GIBS ON CO Y q(�DITOR
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Is claimant vacating a homestead?
State,County.and Township El Yes ��
3N G:bSet,1 Co(�Imb tom.
re of claimant
I hereby certify the above statements are true,correct,and complete. l/,5..0'
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)
I_ E.- t ov
_rci Oaf.k.f1dCisa Ir . .
NON VALDENTIAL
ASSESSOR USE ONLY
ASSESSED VALUE HOMESTEAD VALUE
Land not exceeding one(1)acre immediately (1) .s- --
surrounding residential improvements
Other land
Total land(line I plus line 2) (3) --
',,,
Residential improvements or Dwelling (4) ----
annually assessed mobile/ Garage (5)
manufactured home t d
Other Improvements (6) x
Total Improvements(line 4 through line 6) (7) -- --
Total value (line 3 plus line 7) (8)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./i
Date signed(monthY. year)
Signet k Auditor A ��CO/ s+ O� -
• DISTRIB
UTION: Original(-�`County Auditor,File-Stamped Copy-Taxpayer
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