Homestead_Madison s_twn CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y -_ A STANDARD/SUPPLEMENTAL DEDUCTION FORM I,C.J^��
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.
I(We) (LJile ' d�V\ 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 ort the date this application is signed, (date of signature). I(We):
D 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.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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PROPERTY DESCRIPTION
County ^ Y Taxing district(city learn,township)
Parcel number J Legal description Ism reperry in vuestien:
Real property ❑Annually assessed mobile home(/C 6-1.t-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sumo ds al structure is used to produce income,describe the use and portion
of the property utilized to produce income
26-OVk-- 26 - 2 t 02- Oc b - 0 �
State.County.and Township Is i ant vacating a homestead?
Yes ❑ No �Th
i
Signature of claimant� t
I hereby certify the above statements are true,correct,and complete. r�
Address of contact(number and street,city state,and ZIP code) Address of vacated hornestea if any(number and street,city state,and ZIP code) 1_
401 UJ Pw kansas sfi N`40r- f1-49- 0 .',.,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements _ ED - - G
Other land (2)
Total land(fine 1 plus line 2) (3) J
Residential improvements or Dwelling (4) CD
annually assessed mobile/ At f l i 9 20.22 • t
manufactured home Garage (6) iN V
Other improvements (6) - / __ W
'th_Total Improvements(line 4 through fine 6) (7) i --�jt1I/ a.a
(line 3 plus line 7) (8) GIBSON COUNTY AUDIIOR
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. Q
Verifying action-Signature of Auditor Date signed(month,day,year) ---Vl
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/C 6-1.1-12 to a mobile home $
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that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1.12)of the assessed v f the mobile home or manufactured home.
Signature Auditor t Date sig�, a(mcnh,day,year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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