Homestead_Brewer (2) YEAR
CFOSAIII' \V\ Ai<1) TC2i )
- CLAIM FOR HOMESTEAD PROPERTY TAX RECEIVED FORM I \"."1,0
STANDARD / SUPPLEMENTAL DEDUCTION
W..
IHC10
}� State Form 5473(R18/1-20) JAN 1 1023
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.
CERTIFICATION STATEMENT
I(We) Justin Brewer
certify that I (we)occupied as my(our)principal
place of residence or am(are)buying the following described real property�yja.der ontral t for which a Homestead
(date Property I Tax
Standard
Deduction is hereby claimed on the date this application is signed, 1—\ I — ////'��'GG�.77
I2I Own. 0 Am (are) buying under recorded contract.
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative
housing
cohe poronit of a qualified personal residence trust.
on.
El Have a beneficial interest in the trust or the right to occupy the property under
❑ Am (are) the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Record number Page
Recorder's office where contract is recorded
PROPERTY DESCRIPTION
Township Taxing district(city,town,township)
County USVQ�(]�T 1`_
Gibson Johnson \(tov
Legal description Is the property in question:
Parcel number ❑ Annually assessed mobile home(IC 6-1.1-7)
m Real property
26-19-31-301-000.048 009 Pt SW 31 (. (1) A)
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 in_ 6 11 l— J I — 3 O 1 - O 0 0 /�-t L\ 58 - O O 9
2 ,V CXJ
PROPERTY OWNED ELSEWHERE BY CLAIMANT Is claimant vacating a homestead?
State,County,and Township m Yes ❑ No
Indiana, Gibson County, Montgomery Township Signet of cl i a
I hereby certify the above statements are true, correct, and complete.
Address of contact(number and street,city,state.and ZIP code)
Add ess of vacated homestead,if any(number and street,city,state,and ZIP code)
IN 107 E Gibson St, Haubstadt, IN 47639 I 7195 S 500 W, Owensville, 47665
NON-RESIDENTIAL
ASSESSOR USE ONLY
ASSESSED VALUE I HOMESTEAD VALUE VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2) ]ram
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
-9� r,
annually assessed mobile/ Garage (5) ��
manufactured home -
Other improvements (6) O�0,, t O�a�
Total improvements(line 4 through line 6) (7) G�Tj- .S—,
Total value (line 3 plus linen s.>te signed(month,day,year)
I hereby certify the above is true,correct,
Signature of Assessor 0.
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 isx 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 mobobile home or manufactured home. Date 'gned( onth,day,year)
Signature of Auditor �1\f\-��'" J `1 `1-4 2-3
3
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
3/131101,
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