Homestead_Dodge CHC10CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION �2�
State Form 5473(Rib/1-23)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 111
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under _ • 1. 2-
CERTIFICATION STATEMENT
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I(We) fin xi i certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real prop," under contract for which a Homestead Properly Tax Standard Deduction isllll#bby Iir�d gry74
date th' plication is signed, (date of signature).I(We): J VV 11._ JJ LL(UJL�
2.6wn. El Am(are)buying under recorded contract.
❑Ant(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 21-€4 e...t 4 ri al
❑Am(are)the shareholder,partner,or member of the entity that owns the property. G I B S O N COUNTY A U D I-O R
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County �� Township 0 2 Taxing District(city,to�ownsh�pJ
Parcel Number J v Legal Descriptio ^ Is the pro in question:
/3/?) / 1 ` S 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
026 ' 11 -la - 0203 ^ CO/. 90 7 - 0 A 8
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is Claimant Vacatinntlomestead7
0 Yes No
Signalur lei nl
I hereby certify the above statements are true,correct,and complete.
/ Address of Contact(number and street,city,state,and ZIP code) Address of Vacated Homestead.if (number and street,city,slate,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I 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)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
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.
Verifying 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$48,000.
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 ` ,.l/ p/�r '� Dale Signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer 7....z.7....c.......,
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