Homestead_Hidbrader (2) "'��9� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR ) \J
iX FORM
STANDARD
( HC10
�,N i�/ State Form
5473 by the(R19e /1-2'
�Cr•� Prescribed by the Depanm 'Locai Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Social Secunly,driver's license.state identification and federal identification numbers are confidential under lC 6-1 1-12-37.
LL CERTIFICATION STATEMENT
I(
the ol�lo1wing described real property under Contract for which a Homestead Property Tax Standard Deduction:s hereby claimed on the
date this application is signed, M/pZ V.2,11 (date of signature) I(Wei
rit<n El Am larei buying under recorded contract
0 Am(are)entitled to occupy as a tenant-stockholder 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 entty that owns the property
,
CONTRACT RECORDED
If Buying on Contract Fee Simple Owner's Name {I
Recorder's Office Where Contract is Recorded I Record Number I Page i
PROPERTY DESCRIPTION
County Township 8 ,I "axing District(city town.township)
tbSOn /I - I40,0b61—
Parcel Number Legal Descriptio Is the property in question
a4► I $11r 90 9 —coo, 640 —001 Real Property ❑Annually Assessed Mobile Home((C 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure's 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 Vacatingng a Homestead/
IP code
IV( 4, a be fir- , -% , t �-F coo a 411111/•,I, • ark_ .411.11
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) I . I P6
Surrounding Residential Improvement i /�
Other Land (2)
Total Land(line 1 plus line 2) (3) •
Residential Improvements or Dwelling (4) FIT_LED
Annually Assessed Mobile I — —
Manufactured Home Garage (5)
Other Improvements -- (6) I FEB 2 3 2024
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) I(6) tv
Signature of Assessor a {�54E month year.
I hereby certify the above is true,correct,and complete. I GIBSON COUNT AU lTOR
Verifying Action-Signature of Auditor 'Date Signed(date month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 6C- '-- -: ..•,::l or S48 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 not assessed as real property may not
exceed one-hall(1/2)of the assessed value of the mobile home or manufactured home
Signature of Au to Date Signed(month,day year)
L - `WaktA/ ill -- I _aa3/DISTRIBUTION: Original-County Auditor File-Stamped ropy-Taxpayer 3-(r3- 2-Li
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