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Homestead_Bellinger 0 CLAIM FOR HOMESTEAD PROPERTY TAX gg STANDARD/SUPPLEMENTAL DEDUCTION FORM Y�A/ i Stale Form 5473(R19/1-23) HC10 v�,('(lf� Prescribed by the Department of Local Government Finance 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 A ��i r^ I(We) ' l p 1.LO Ll, 49 r�/ '."'i 7v certify that I(we)occupied as my(our)principal place of residence or am(are)buying the tQll�v�I�rJrt�tg-d aliproperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the �daate this application is signed, ttJJ /Gl�J/.C(f 7 (date of signature).I(We): t7S!Own. El Am(are)buying under recorded contract. ❑Am(are)entitled la 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. ❑Am(are)the shareholder,partner,or member of the entity that owns the property. CLAIMANT'S INFORMATION - CONTRACT RECORDED If Buying on Contract,Fee Simple Owner's Name <f Recorder's Office Where Contract is Recorded Record Number Page E.b PROPERTY DESCRIPTION Co `A �D Township/LSA/I Taxing Dlstri�t(ci ,fawn,township) Z024 �r Parcel Number Legal Description Is the property In question: G/e5 V v /n/ �Raal Property ❑Annually Assessed Mode Hcn€Ft, 1�T- ©pyyr,��( If any potion 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 idrt, U �1 of the property utilized to produce income. Q/�.O R a_6 -18 -O 1 -/o (-oaa, / . -oaf PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacating a Homestead? Yes ❑No .,gnature of Claimant . .. . . .. . .. . I hereby certify the above statements are true,correct,and complete. /�/ _ Add ass of Contact( mber and street,city,slate,and ZIP code) 'L•.:a/.l �..^d Ho estead,it any(nu bar and street,% ,slate, d ZIP code) /t 1 �hRST5T 4 ��li — _ 1 o�U- t��- �w �Vrr , ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE 476�s Land Not Exceeding One(1)Acre Immediately (1) tY 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 (5) . • Total Improvements(Line 4 through tine 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 Dale Signed(date,month,year) STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 607.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-had(1/2)of the assessed value of them bile home di .9/ o/r,,manufact red•home. r1 Signatur onatur o;Editor ✓1/t'L�J Date Signed onflt,dsty.yyr')rt /I/ / P11) DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2 F I LED • ,06a JUL 2 9 2024 id,":1 6eitc---- i))1/4 - �� �� GIBOUNTY AUDITOR ❑ Date: June 27, 2024 Roman Ricker, Magistrate Gibson Superior Court Distribution: I`.cota. deli`rszyz r Petitioner Name& Address 504 E rl ritilone;y S1 O u;vl112 -Toff s 1v71an ,')0.i1:., 1 Respondent Name& Address 30'f M0413 <i}_ 11<) t7(p05