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Homestead_Engle •- •_a. CLAIM FOR HOMESTEAD PROPERTY TAX _ {1 STANDARD/SUPPLEMENTAL DEDUCTION FORM IW . State Form 5473(R18/1-20) HC10 • 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. CERT=ICATION STATEMENT I(We) i r ' certify that I(we)occupied as my(our)principal place of residence or am(- e)•uying - ollowing descri 2 d real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is igned, (date of signature). I(We): ❑ Own. 0 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. Recorder's office where contract is recorded Record number Page County Township© 2.•_% • •Taxing district Icily town,township) — Parcel number \ Legal description 4 I Is e '.operty in question Real property ❑ Annually assessed mobile home(IC 6-f.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou s t t structure is used to produce income,describe the use and portion of the property utilized to produce income_ 6 - 1 irg -�-6 -3IoO- o2 s=O2L1 . State.County.and Township Is cl iman acating a homestead? es ❑ No Signature of claimant I hereby certify the above statements are true,correct,and complete. Address of contact(number and street.city,state,and ZIP ) • Address of vacated homestead.if any(number and street.city state.and ZIP code) X ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding one(1)acre immediately � r surrounding residential improvements (1) ''°' '�'-' """s=- Other land (2) __. ..-- �1''ix. Total land(line 1 plus line 2) (3) JUL 1 5 202 Ir.� . ..,i Residential improvements or Dwelling (4) M+l`h annually assessed mobile/ manufactured home Garage (5) 01111111111.1111111101.4 Other improvements (6) if" ' Total Improvements(line 4 through line 6) (7) GIBBON COUNT 'I)rraR Total value (line 3 plus line 7) (8) 1 hereby certify the above is true,correct, Signature of Assessor Date signed(month day year) and complete. 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 S that is not assessed as real property or to a manufa red home that is not assessed as real property may not exceed o -half(1 of the asse value o e mobile home or manufactured home. Signature or Date s'ned(m day a �l ^ J I I. ` rll"J C..- OISTRI TION: Original-County Auditor, le-Stamped Copy-Taxpayer J\ • Page 1 of 2