Homestead_Bough 'f' x CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION FORM -_ YEAR
r ;/ State Form 5473(R19/1-23)0HC10 a3
Prescnbed by the Department of Locai 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) V pifer Jr ,. A oilmn ►•.0. certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, II'I�23 (date of signature) I(We)
Ir Own 0 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
0 Am(are)the shareholder,partner,or member of the entity that owns the property
CLAIMANT'S INFORMATION
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office W Record Number Pagehere Contract is Recorded
PROPERTY DESCRIPTION
County Township 0 rl� Taxing Di tntt(city.town,township)
G 'bSnv1 LTOto1lL4:4- (ewn51`►t
Parcel Number Legal Descnphon Is the property in question
—'I..i 5'' ..)p"-- (09.g 3 8"'OD, 13 Real Property ❑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 Towns iel Is Claimant Vacating a H/orriestead?
' ID Yes
Signature im I
I hereby certify the abo s ements are true,correct,and complete 1 '2L-x-rt 0 3---y
YAddress of Contact d street,oty.state and ZIP .e) I Address of Vacated Homestead If any numbe n street cyt.state and ZIP code'
30/ I.J 51.1 a rtnceicr .,,v1017P -�-r A A-✓„1t..N.
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I'NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) • rTotal Land(line 1 plus line 2) (3)Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) NOV 1 4Other Improvements (6) /� /
Total Improvements(Line 4 through Line 6) (7) +/��a`�Z�CaC C G .b'(Y.LLA;a (/III//
Total Value(Line3p/us Line 7) (8) GIBSON COUNTY AUDITOR
Signature of Assessor l Date Signed(date.month.year)
I hereby certify the above is true,correct,and complete.
Ventying Action-Signature of Auditor I Date Signed(date month.year)
STAIIDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 848.000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
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 oror manufactured home �/
Signature of Audi f /11 _" -_ Date Signed(fi t wear)
-;�17�- 1/ 1 3
DISTRIBUTION: Onginal-County Auditor File-Stamped Copy-Taxpayer
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