Homestead_Houdyshell `xn • —\ CLAIM FOR HOMESTEAD PROPERTY TAX1.1
y< ! STANDARD/SUPPLEMENTAL DEDUCTION FORM
.,,..
s' timfrj State Form 5473(R18/1-20) HC10
• ISM D
Prescribed by the Department of Local Govemment 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- . -12-37.
�/ CERTIFICATION STATEMENT (�
I(We) / Q/YL 9t i�T/ A - - s " ( )occupieda• p t cipa 2Z
certifythat 1 we as m ci a
place of res'%ence or am(are)buying the following described real•roperty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of sip aat�ure)). I(We):
a..filrelt1)
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. GIBSON COUNTY AUDITOR
❑ 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
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township I Taxing/rict(day town.township)
Parcel number LSgarl description ^ , // I Is theme p/royerry in question
P !~S V 3 /�-/ b Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceedin'9 fre tlICIMIhmediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
a 4-0 '/- A s - /oY • 000.. o,./.8-va- 6
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is clai nt vacating a homestead?
BEE Yes ❑ No
xAignat fclaiman(
I hereby certify the above statements are true,correct,and complete. +I�/(}�o� ////
Address of contact(number and street.city.sntate,'and ZIP code] Addres of vacated homesteatl.i ny(number and street,city,state,and ZIP rode)
303 S gtaitSi. s 'ZJ Aca / Y�6Gc
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
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/ "_-- — .
manufactured home Garage (5)O •
ther improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I 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 S45,000.
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 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.
Signature of Aud V aso !I—� 1 Date signed(month.day year)
DISTRIBUTION:Original-County Auditor,File-Stamped Co r41r1-
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