Homestead_McEllhiney ,4-1,,,,,,,
FORM
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION HC10 � �State Form 5473(R18/1-20)
,.,. / Prescribed by the Department of Local Government Finance �► 1� /�
INSTRUCTIONS:See reverse side for filing instructions. r I `V� LC 1/
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under 6- .1-12- 1 [" J
iCERTIFICATION STATEMENTI(We) b m,1n 'ICJ PVl C h I nN certify that I(we)occupied as my(our)principalplace of resident oam(are)buying the following described r property under contract/ f wh,l a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, I a/ 8/t� (date of signature). I(We): �j
ErOwn. 0 Am(are)buying under recorded contract. `^�/�
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. \iN
❑ 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.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town, ownship)
( o Ge r
Parcel number Legal description th roperty In question.
d
6-lJeV (J l't - ?OO_70 I, 3c-7- o D L} l m Real property ly assessed mobile hoe(IC 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surr rids th structure is used to pr uce in me,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 homestead?
❑ Yes ❑ No
• ature ofclaimant ) G
I hereby certify the above statements are true,correct,and complete. l
' �- r
Address of cdrlltM igiillaNarld✓ we oi♦x..loo AO ZIP tads • Addr of vacat homestead,if any(number and street.city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) FILED
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7) UE C 2 8 2023
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor n pi/MVO ned month,day.year)
and complete. C C GIBSON COUNTY nlSaR`'
l
Verifying action-Signature of Auditor signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that 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- my Auditor,File-Stamped Copy-Taxpayer
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