Homestead_Alstatt !4..,,r�. CLAIM FOR HOMESTEAD PROPERTY TAX
c STANDARD I SUPPLEMENTAL DEDUCTION
FORM YEAR
itio
/` State Form 5473(R19/1-23) HCIO a3
� / 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) rrt('e.W A\s,,,,, kar -_—... certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followin descried real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
datete this application is signed. IQ(9�a (date of signature) I(We)
D Own ❑Am(are)buying under recorded contract
❑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
❑Am(are)the shareholder,partner,or member of the entity that owns the property
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxi Distnct(city,town,township)
G.bso q 1 o..r—my\
Parcel_Number ]�7n[ Leegalal�DDescription Is the property in question
. 4-ao-4 V-too-ow. w v^Oat Real Property 0 Annually Assessed Mobile Home(IC 6-1 1-7)
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
�aaHH jp.stead'
❑yes tffNc
i Signature of Claimant 111
I hereby certify the above statements are true.correct,and complete
Address of Contact(number and street.city state and ZIP code. 'd•ess of Vacated Homestead.Iiany(number and street.city,state.and ZIP code)
SBl E 9005 be.L- . 74 13 „,.A%JT/ . o 'aS�ll c;. e -k:.4
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately ;)
Surrounding Residential Improvement _
Other Land (3) F iT1ED
ToTotal Land(line 1 plus line 2) (3)Residential Improvements or Dwelling (4)
Annually Assessed Mobile I H — _ AUG 0 9 Z023
Manufactured Home Garage I(5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) ykattd O
Total Value(Line 3 plus Line 7) (8) GIBSON AUDITOK
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above Is true,correct,and complete.
Verifying Action-Signature of Auditor Date Signed(date month.year) 61•
STANDARD DEDUCTION ALLOWANCE ^,v
20 Pay 20 Lesser of 60%of the ac,essed value of the homestead or 548,000 `V
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home that $ `w`
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 Auditor Date Signed(month.day. rl,_
eV 1
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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