Homestead_Goldsberry e- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM C\�, '• ./ State Form 5473(R19/1-23) HC10
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) - \ R• ,S -C certify that I(we)occupied as my(our)principal place of
residence.r am(are)buying the foll wing described eel property under contract for which a Homestead Property Tax Standard Deduction is hereby clamed on the
dateil�, this// application is signed, WI\ a3 (date of signature) I(We)
lrOwn dAm(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
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing District(city.town.township)
G\bSon 0 4er,�er
Parcel NumberLegal Description s the property in question
24-13-3OI.=y —000 h \— 004 eel Property ❑Annually Assessed Mobile Herne(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 a estead7
❑ No
Sign tare of r
I hereby certify the above statements are true,correct.and complete
Address of Contact(number and street.city,state.and ZIP code) Add of Vacated Homestead,if (number and street.city,state.and ZIP code)
• IE O J`A/K l o T J
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD vALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3) ji'
I L E D
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
NOV172023
x7
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) YkGfu(Lt C G..v1
Total Value(Line 3 plus Line 7) (8) GIRSON COUNTY Al lffiTQR
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 S48.000
Notwithstanding any other provision,the sum of the deductions provided in/C 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 or manufactured home
Signature of Auditor Date Signed(month,day.year)
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2