Homestead_Bullington •_a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a --.- 8 STANDARD/SUPPLEMENTAL DEDUCTION FORM
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State Fond 5473(Rt 6/1-20) HCI O
;• 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/C 6-1.1-12-37
CERTIFICATION STATEMENT
I(We) V______41I+_Z 2 IIf•� �� certify that I(we)occupied as my(our)principal
place of residence•r-m(are)buyine e foil,win• •e-cribud r=-I•roperty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this-pplication is signed, (date of signature). I(We):
Kwn ❑ Am(are)buying under recorded contract.
m (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 owners name
- Record number Page
Recorders office where contract is recorded
PROPERTY DESCRIPTION
County SO Township 1, /� Taxing district(city town.mwnsh
Parcel number I Legal description Is th p perty in question
Real property ElAnnuAnnuallyassessed mobile home(/C 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun 5 th structure is used to produce income,describe the use and portion
of the property utilized to produce income
ZG—�Z—�7-4O 0o\ -C
,.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township is claimant va tin a homestead?
❑ Yes o
-- -— 'Signature of claimant .�
I hereby certify the above statements are true,correct,and complete. �i __ `, p� Q _
Address of contact(number an freet.city state.and ZIP code) ( Address of vacated homestead if (number and street city state.a IP code)
ASSESSOR USE ONLY
ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
surround ng estident al improve en diately (1)
Other land (2) --- ---—"- _ "—
land(tine plus line2) (4)
FILED Residential
improvements
ovemeentts or Dwelling (4)
annually assessed mobile/ Garage (5) - - -
manufactured home
Other improvements (6) DEC 1 3 2022
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (a) L�LQ.G� J t ( yea')
Signature of Assessor e,�
end co pletifytheaboveistrue,correct, GIBSON COLNTY AUDITOR
and complete. _ - -- --- ---_
Date signed(month,day yeah
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
t�urreedddhome that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of� oWt6 home or manufactured home.
Signature of Audko>;_ II Date signed(mo th,day.year) -
\r n1\, N7=is I Z 13 1r0 2
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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