Homestead_Fougnies _{
e;� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
i% State Form 5473(R 19/1-23) HC1 r7 3
Prescribed by the Department of Local Government Finance
INSTRUCTIONS'See reverse side for filing instructions.
NOTE.Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1.12-37
CERTIFICATION STATEMENT
I(We) ' JT OV /1 eS certify that I(we)occupied as my(our)principal place of
residence or.m(are)�ymg the following scr bed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date application is signed. IV 1I ol3 (date of signature) I(We)
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
CLAIMANT'S INFORMATION
Name of Claimant(legal name) Telephone Number of Claimant Email Address
Corey 5 Foy gr�.ts (g/r ) 77-//IO
Social Security Number of Claimant(last Eve digits) Driver's License/Identification I Other Number of Claimant(last five digits) Issuing State
�38 q (Applicable only d applicant does not hay a social security number) � /
02
Name of Claimant's Spouse(legal name)
Social Secunty Number of Claimant's Spouse(last five digits) I Driver's License/Identification I Other Number of Claimant s Spouse(lastfiee dots) Issuing Stale
(Applicable only i/applicant s spouse does not have a social security number)
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claim scaling a Homestead?
Y- 0 No
1 9rgnalure of•C,aI nt
I hg�the at) v statements are true,correct,and complete '
)17
d • of Contact(number and street,city state and ZIP code addr ss of V. ed1H.Est-_ .ny(numb et city,state.and ZIP code)
r.•r IA Pcti lice •vl ` 7Po r E Rd : e • 7. O
110 N o tom. h K ?GY
ASSESSOR USE ONLY - . •V H• c A a A N s. • �i-b+••
N. and Not Exceeding One(1)Acre Immediately �_ j-
1\� urrounding Residential Improvement -� .....„..1
( ,•r p' /{A�`
Other Land (2) �1T5 CAA vim+ Q �
I1 .✓
Total Land(line 1 plus line 2J (3) II:;"J IIE 1I1 �— 1 l Residential Improvements or Dwelling (4) 2 irl‹)13
Annually Assessed Mobile/ v
Manufactured Home Garage (5) •
•l) Other Improvements (6) N O V 0 2023 ,/___,
rj Total Improvements(Line 0 through Line 6) (7) I
Total Value(Line 3 plus Line 7) (8) AaL a ,p to 8wYg9 tl,(
Signature of Assessor GIBSON COUN tTaAWllt✓I[month.year)
I hereby certify the above Is true,correct,and complete. T AlJ7J1 I IVVJ tttttt
Verifying Action-Signature of Auditor Date Signed(date.month.year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed.,a:.n Jf the homestead or$48,000
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 Audi r Ia ---_
Date Signed(month,day.year)
id lCir401,1/. ' /V it/ I/_19 3 _ _
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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