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Mobile Home_Hedge CLAIM FOR HOMESTEAD PROPERTY TAX YEA ..� STANDARD!SUPPLEMENTAL DEDUCTION FORM State Form 5473(R19 t 1-23) HC10 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 I(We) t✓i€J 6 r V G- certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, (date of signature).I(We): XOwn. D Am(are)buying under recorded contract. ❑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. ❑Am(are)the shareholder,partner,or member of the entity that owns the property. CONTRACT RECORDED If Buying on Contract,Fee Simple Owner's Name 06 Recorders Office Where Contract is Recorded Record Number pdg 2024 PROPERTY DESCRIPTION County Township — Taxing District(city,town,township) OA, O (:0 y'y P�Numbbjejrf� /t rJJ [' Legal Description Is the property in question: 4. t lJ��� 6.7✓�t7 o ❑Real Property tT�/�1 Annually Assessed Mobile Home(IC 6©1 7)OR 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. PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacating a Homestead? ❑Yes o Signature of Claimant I hereby certify the above statements are true,correct,and complete. r Address of.C.•'c'rmAra„ft-Ira i tate.and ZIP code) `• - 4 %. .dress of Vacate ome.-f.,if any(num..4 and street,city,state,and ZIP code) ASSESSOR USE ONLY I ASSESSED VALUE ' HOMESTEAD VALUE 'NOt1-RESIDENTIAL VALUE Land Not Exceeding One(1)Acre Immediately (1) Surrounding Residential Improvement Other Land (2} Total Land(line 1 plus line 2) (3) Residentiallmprovementsor Dwelling (4) AUG 0 9 2024 = 4 Annually Assessed Mobile I Manufactured Home Garage (5) ��r L ` Other Improvements (6) h7t),u%rcrc[{ L;, 1iY.2�rEinti} Total Improvements(Line 4 through Line 6) (7) GIBSON COUNTY AUDITOR 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. Veri,m Actiolt-Signature.f Au,,to • -Date Si.n,d(date, t� r) . r `/%�'�,)] 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/C 6-1.1-1210 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(112)of the assessed value of the mobile home or manufactured home. Signature of Auditor Date Signed(month,day,year) DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2 4