Homestead_Sprinkle j �‘ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
`p;• t STANDARD/SUPPLEMENTAL DEDUCTION OR
\rri/ State Form 5473(R 19/1-23)
-. 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) I�CAAe.� wwy(Q SremAt. ._ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying thl,'following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. O lt!'S (date of signature) I(We)
LSOwn ❑Am(are)buying under recorded contract
❑Am(are)entitled to occupy as a tenant-Stodtholder 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 Where Contract is Recorded I Record Number Page
PROPERTY DESCRIPTION
County Township Taxing Distnct(city.town,township)G•
l V% O2T 7?MoV �own�ll"'
);P
Parcel Number -yI ...tfLegal Description Is the erty in question
?D_11-‘4-0�00- ,,8a�C` C'7 Real Property ❑Annually Assessed Mobie Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun 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 omestead'r
0 Yes 4.4 No
Sign m ur of Claiant •
I hereby certify the above statements are true,correct.and complete !/ ✓ mam
Lo.a
Address of Contact(number and street,city.state and ZIP code) d� cress of Vacated omeste if any(number and street city.state.and ZIP code)
a " 50 S '• ' _• -. ii. - 0
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately t 1)
Surrounding Residential Improvement _ '
Other Land (2) IIE_aii1Thh1)
F
Residential Improvements or Dwelling j(4)
Annually Assessed Mobile/
Manufactured Home Garage (5) JC SE? 1 1 11 2023
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) ASIAl-C C-(.s'I
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 of Au'tor / _W Date Siggnned(month,day.year)
ad
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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