Homestead_Stewart (2) 13:0.•4; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
ItXto.,. State Form 5473(R15/1-20) HC1 0
Prescribed by the Department of Local Government Finance
INSTRUCTIONS'See reverse side for filing instruc(ions.
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(VVe) "Dimv‘oNA 5 A-e t pu 6.s--\-- certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract far which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (e)/d 0/09 a 3 (date of signature) I(Vile):
Ern. 0 Am(are)buying under recorded contract.
0 Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation,
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
D 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 I Record number I Page I
. .
PROPERTY DESCRIPTION •
County .., Township Taxing district(city town,township)
GX\Z3 SO n ---e,:vox_.... —10,„,
Parcel number Legal description Is the propyy in question '
261-04-cs)S—'-'i 0 1''•00 D Ola 7 —bp-0 [70,4,s7„property
ET;Annually assessed mobile home(/C 6-f./;7)
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 income
.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is claimant vacating a ho estead?
I
E Yes
i Sn'atii e of olai,77'
I hereby certify the above statements are true,correct,and complete. , 1 •
IAddress of contact(number and street city state.and ZIP code) Address at vacated homestead if any(number and street,city-state,and ZIP code)!
1
Llit)Li kr) V‘f r-i - - .08.c> 0- - ..A1 t4 I
ASSESSOR USE ONLY
I ASSESSED VALUE, HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one CU acre immediately
surrounding residential improvements (1) '
I Other land (2) .
'
Total land(line 1 plus line 2) I(3) .
Residential improvements or Dwelling I(4)
annually assessed mobile I
manufactured home Garage I.(5) JUN . .
,
Other improvements I(6)
Total improvements(line 4 through line 6) 1(7)
I Total value (line 3 pits line 7) I
[(8) 1924C.Ilezej a
Signature of Assessor GIBSON-COUN bfAktiOtTeft.day year)
I hereby certify the above is true,correct,
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$45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
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,
Signatute r.Auktor itif Date signed(month,day year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1012 .