Homestead_Payne CLAIM FOR HOMESTEAD PROPERTY TAX I
I
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YEAR I,STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(Rile/1-20) IHC10I 2022 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 lC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) James&Eva Payne 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, (date of signature). I(We):
,❑ 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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
. .._.. ----- - -
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Patoka Township Gibson, Patoka Township
Parcel number Legal description Is the property in question:
26-11-14-101-001.932-027 COLUMBIA VILLAGE SEC 3 16 m Real property 0 Annually assessed mobile home(iC 6-1.1-7)
If any portion of the 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
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes IZI No r.1\mil/
Si Lure of claimant �`�-I`` O.
I hereby certify the above statements are true,correct,and complete. , Q� C {��J/�/�'
Address of contact(number and street,city,state,and ZiP ccde) f�j scaled omeyaarl,n (nu d street,city,state,and ZIP de).'
1806 Cambridge PI, Princeton, IN 47670 see sss sss���vvv
ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2) -
Rotal eside dti l(line mr plus line 2) (3) TTT
Residential improvements or Dwelling (4) ■ ■
annually assessed mobile/ L
manufactured home Garage (5)
Other improvements (6) OCT0 5
Total improvements(line 4 through line 6) (7) ZU22
Total value (line 3 plus line 7) (8)
Signature of Assessor h L,� L Date signed(month,day,year)
1 hereby certify the above is true,correct, �L.LC�17 � LG.et�tdl
and complete. GIBSON COUNTY AUDIT,Ole 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 lC 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 vale \ mobile home or manufactured home.
Signature of Auditor Date sigrbd(r t tlay,yea^
DISTRIBUTION:Original-County Auditor,File-Stamps py-Taxpayer
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