Homestead_Ellis •
CLAIM FOR HOMESTEAD PROPERTY TAX i -
41YEAR l
FORM
STANDARD I SUPPLEMENTAL DEDUCTION HC10 �a
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.
A CERTIFICATION STATEMENT
I(We) de)w(I A reW d-AMn El ;'S certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the followilig 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):
111-twn D 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.
County Township Taxing district(city.town,township)
Parcel number Legal description i Is the property in question:
:e-%.1 /' l— �— 7 � eel property ❑ Annually assessed mobile home(IC 5-I 1-7)
AF- - . �`/ exceeding one(C61 y s rrepn
1 . O n'o IF C idenoaI 5tr incoremar the land not 1)acre that immediate) ds that structure is used to produce income.describe the use and portion
y( =pr..e pr
SEP c'7 2022 �
State,Cqunt Township Is claimant vacating a homestead?
l.y]2 J�/{r/� •
-_-- _ - ❑ Yes ❑ No
•
GIBBON COU TY AUDI-IUK , �`I hereby certify the above statements are true,correct,and complete. �..,
Address of contact(number an��<city state.�Zl`Code)
Ad ess of lead.if any.d any( end street,city,state,and ZIP code)
,a— Dv} r tY/CtG 11 �/C e fr.Y) fit/Y 76)p
ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements -. - -- ,
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) - ?,...
annually assessed mobile I Garage (5)
manufactured home ��� _ - -'-'
Other improvements (6) - - sc.
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) --- 1
- Signature of Assessor Date signed(month.day.year)
1 hereby certify the above is true,correct,
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 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. Date signed(month.day.year)
Sign urp (Auditoritr �� 1(//7/07
DISTRIBUTION: Original•County Auditor.File-Stamped Copy-Taxpayer
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