Homestead_Simpson ,,i!'i�'d', CLAIM FOR HOMESTEAD PROPERTY TAX i _ YEAR l
1l! ' STANDARD/SUPPLEMENTAL DEDUCTION 1ORM
•, �// State Form 5473(R19/1-23)
\! Prescnbed by the Department of Loom Government F:narce
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) �Jt_ Glpr jI t alP 1o✓► certfy that I(we)occupied as my(our)principal place of
residence or am(are)• ying the fo win described al property under contract for which a Homestead Properly Tax Standard Deduction is hereby claimed on the I
date th s application is sgned. /9//ct/Al 3 (date of signature) I(We)
Own El AM(are)buying under recorded contract I
0 Am(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
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorders Office Where Contract is Recorded j Record Number Page
PROPERTY DESCRIPTION
County Township -axing District(city town.township)
G�bsor` 1,-Ia 1-,
Parcel Number Legal Description is the property in question
06—6—OC J 1 WO—coo. t••'r 5— b ee 3 I eat Property 0 Annually Assessed Mobile Horne(IC 6-1 1-7)
li If any portion of the resdential structure or the land not exceeding one(1:acre:^,al r-,r,e1 ale l su mounds that structure is used to produce income describe the use and portion
Of the property ut lied to produce income
PROPERTY EWHERE BY CLAIMANT
State •-nty,a ownship 2 ( Is Claimant Vacating
sve
� d/ Of r C 4.7 6S 0 Yes ace
I rtify eiebove st emenls are t ).Corr c(y rid comp to !
t
Addre s of Contact(number and sere t.city state and ZiP code) address of Vacated H estead d any(number and street city.state and ZIP code) I
735a5 1 ,, w / -t r, _ :y/0 •�j�.o- ers Pet C I I . � .... .
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) I J ',p 7
Total Land(line 1 plus line 2) _ (3) -- 1L
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
I
Manufactured Home i Garage (5) '
DEC 2 9 202f I
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
mo
Total Value(Line 3 plus Line 7) (6) � C f� AU
lTO
diBSnN COUNTY AURI!T Signature of Assessor ,Date
signed(date month year)
I hereby certify the above is true,correct,and complete.
I Ventying Acbon-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 00C
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-s not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signatureof Auditor Date Signed(month day years
DISTRIBUTION. Original-County Auditor File-Stamped Copy-Taxpayer
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