Homestead_Kohlmeyer * CLAIM FOR HOMESTEAD PROPERTY TAX __ YEAR__
;; STANDARD/SUPPLEMENTAL DEDUCTION FORM
A'; % State Form 5473(R19/1-23) HC10 23
Prescribed by the Department of Loca;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) 54e0ven L/ $rent:'. L oh (v 1 v ye r certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followinidescrWhfal property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. 9 /0/ (date of signature) I(We)
IQOwn ❑Am(are)buying under recorded contract
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑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 VVhere Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing Di Oct(city,town,township)
G tbSon (' r ,}ovx
Parcel Number Legal Description IIIss---the
ep�property in question
A-/a-O(ry-3Ol -Ooa? OSS-0a e L-Irxeal Property ❑Annually Assessed Mobie Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(I)acre that immediately surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income N
N
PROPERTY OWNED ELSEWHERE BY CLAIMANT \
State,County,and Township / Is Claimgpt Vacating
�t1a Homestead'
`�1
rellYes
Signa!ur- merit //
I hereby certify the above statements are true,correct,and complete
// ,s
Address of Contact(number and street.city.state and ZIP code (Add- . Vac Homestead.ff: y(Almb a1xiettty.ste•.an-AP-code) 0
11(( N A L ?C\A R-tO "3- `{7G 70 - '0 50e rangy cO
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON RESIDENTIAL VALUE 0
Land Not Excoeding One(1)Acre Immediately 1 0
Surrounding Residential Improvement d
Other Land (2)
Total Land(line 1 plus line 2) (3) FILED
Residential Improvements or Dwelling (4) 0
Annually Assessed Mobile/
Manufactured Home Garage (5) _ AUG 1 0 2073 - Q
Other Improvements (6) wv,‘"
Total Improvements(Line 4 through Line 6) (7) A C 6: nd
Total Value(Line 3 plus Line 7) (8) GIBSON COUNTY AUDITOR
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)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548,000
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 A ;tor lW 4 V _____— Date Signed(month.day.year) — _
-_
S//o/a3
DISTRIBUTION: Original-County Auditor.Fite-Stamped Copy-Taxpayer
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