Homestead_Rexing -':,;. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
tvi. . . '}, STANDARD/SUPPLEMENTAL DEDUCTION ^_�\
State form 5473(R18/1-20) HC10 �'� 4, \ Y
‘ � Prescribed by the Department of Local Government Penance FORM
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INSTRUCTIONS:See reverse side for filing instructions. (^IfV/J7
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
L ' c1,5 .
I(We) ('11 1t1P 1 CY 1 certify that I(we)occupied as my(our)principal (k(_n
place of residence•r am(are}.Auying the fling described real property under contract for which a Homestead Property Tax Standard r 1 (�'
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): l''s \'
4Own. ❑ Am(are)buying under recorded contract.
j Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
I ❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
I
Parcel number Legal description Is the perty 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 surro ds t t structure Is used to produce income.describe the use and portion
i of the property utilized to produce income
24_ \-4 - 15- 100 -00 - ,a0 - 021 .
N
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township IS CI i nt vacating a homestead?
Yes ❑ Noglik _'/
l-•na,re fcla ntf_- - --• 1T7i
jI hereby certify the above statements are true,correct,and complete A
' Address of contact(number and street,city state and ZIP code) II•d•ss of va .ed homestead if any(c;-ter and street rty state.and ZIP code)
g04-4- t- 6sos 0Ole. - n- -66 90 9- W 6 S Vv;�1c -Jf1 -l.l )— o
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL C
VALUE
Land not exceeding one(1)acre immediately x" I
(-surrounding residential i (t)mprovements : �i�'
L Other land (2) ? ,Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) ?441y," et-
annually assessed mobile/ (_)
manufactured home —Garage (5) _ I t
Other improvements (6) iVt' ;j;r , i•r a
r—Total Improvements(line 4 through line 6) (7) I N
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, ,s, eatu•e of Assessor mate signed(month day year)
and complete. -GIB SON CO NNTYAUDITOR
Verifying action-Signature of Auditor Date signed(month day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6.1 1-12 to a mobile home S
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 valu- • •t•bile home or manufactured home.
Signature of A itcrks/30. Date sig ed(mo h.day year)
DISTRIBUTION: Original-County Auditor.Fite-Stem. • xpayer
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