Homestead_Blann a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
\�\ STANDARD/SUPPLEMENTAL DEDUCTION FORM �r�
/ State Form 5473(R19/1-23) HC10 W
•ice Prescnbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Security,dnver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37
���� CERTIFICATION STATEMENT
I �.�.�"�(We) L7L11. certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the (o n•sift rd}-e�l•iroperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
to is application is signed `('It (/ C�J (date of signature) I(We)
I n ■Am(are)buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
El 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
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing Distnct(city,town.township)
Parcel Number Legal Descnption s at property in question
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 su and that structure is used to produce income.describe the use and portion
of the property utilized to produce income
z6 __12___-07 -2 ___ 0(72_ _022 -02_2 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
r ant Vacat;.i. omesJill
Li Yes �. II
. Si a u or Claimant
I hereby certify the above statements are true,correct,and complete P /���
Prihp
r s of Contact'umber and street.city.state and ZIP code) ddress of vdl Ho,�a ca^d_if any inu brr d street city.start=�d 7aP code,
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ASSESSOR USE ONLY ASSESSED VALUE 1 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)
I
Residentialnally ImprovementsMobile
/ Dwelling (4) 0 5 20233
anufl AssessedH Mobile I DECt J
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) GIBSON COUNTY AUDITOR
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date month.year)
I hereby certify the above is true,correct,and complete.
Venfying 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 5
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 ctured home
Signature of Auditor ( 1 Date Si�rtay(m n(h. ay.yperr1 _ .
DISTRIBUTION: Ongieal-County Auditor.File-Stamped Copy-Tax ///)- \J\ I - v/^\/)
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