Homestead_Besing (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
". STANDARD/SUPPLEMENTAL DEDUCTION FORM
°‘..1i40,,,I State Farm 5473(R18 I 1-20) HC10 09 3
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Soda)Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37,
CERTIFICATION STATEMENT
(We) \IG v,p, certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the toadying described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, as/a s (date of signature). I(We):
r_S°15revn. CI Am(are)buying under recorded contract.
O Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
O 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
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
CVNbe-JOr.'1 0§1/4VAP•491.C1 +5
Parcel number Legal descp° Is the p o . n question:
PG* Ct eat property IrIVAnnually assessed mobile home(IC 6-1.1-7)
It 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 El No
IiRoaalur arm:
hereby certify the above statements are true,correct,and complete.
igt
Address of contact(number and street.city.state.and ZIP code) Address of vacated homest ad,if any(number and street city. ate, nd ZIPcode)
54-. • ‘4k- C.; 44o
ASSESSOR USE ONLY ASSESSED VALUE. HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land I(2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (4)
annually assessed mobile
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs line 7) (8)
Signature of Assessor Date signed(month,day.year)
I hereby certify the above is true,cariect,
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 645,000.
1 lir
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. APR 2 5 2023
Signature of Auditor
tqlJeCit Date signed(month,day,year)
i*L
DISTRIBUTION:Original-County Auditor,FileiStamped Copy Taxpayer
Page 1 of 2 GIBSON COUNTY AUDITOR