Homestead_Blubaum !`,1 °'\ CLAIM FOR HOMESTEAD PROPERTY TAX
x ' STANDARD I SUPPLEMENTAL DEDUCTION FORM YEAR
i�/ 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) ZAP h ' U. , \ • certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the foil s ed re r rty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
xr,
his application is signed, tI (date of signature) I(We)
wn ❑ (are)buying under recorded contract
(are)entitled to occupy as a tenant-stodcholder 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
Issuing Stale
(Applicable only if applicant's spouse does not have a social secunty number)
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Townshi• t Taxing District(city.town.township) CO
1oV onov o� J
Parcel Number Legal Descnption e property in question
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 sun un s that structure is used to produce income,describe the use and portion
of the property utilized to produce income
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—23 -Ql --(oCoco'-
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Va g a mestead?
❑Yes o
Signature of Claimant
I hereby certify the above statements are true,correct,and complete
Address of Contact(nurpberWW fnd street.oily.state.and ZIP code) to tl tl s of vacated mestead d any(number and street.city,state and ZIP code)
1 1 ,V11111iz ' " 111I1.s 1 +
ASSESSOR USE ONLY 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) Frib7ED
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ NOV 27 2023
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) Ad iCGe a. 1AVkr.
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 S
is not assessed as real property or to a manufactured home that is sed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home r anufact d home
Signature of Auditor r 11 • Date SIT(n t d ("1 D
___
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxp
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