Homestead_Wright (6) e- rye' CLAIM FOR HOMESTEAD PROPERTY TAX iiinaiii
','' ' STANDARD!SUPPLEMENTAL DEDUCTION FORM A
4'�.. State Form 5473(R19/1-23) HC10441w�fl
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) CR Q 1c X'SC,
C, LAD f' ac, 1 . certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described ai property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
,d_a..t,e�,,tt/hhiis application is signed, -pl—(1•at s (date of signature).I(We):
pdOwn. El 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 en Contract.Fee Simple Owner's Name • 1r
Recorder's Office Where ontract is Recorded Record Number Page
•
PROPERTY DESCRIPTION (�
Cm. Township Taxing District(city,town,township) 4
I bC''m ( GiQSOA,CO 2
Parcel Number Legal Description the pro rty in question:
�.! eat Property ❑Annually Assessed Mobile Home�C eA 4y,��, '�Q/
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.
(DLQ .,\ t_k-- tot - kC k_ oc io, - cc 7 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating
alra Homestead?
rrng
❑Yes ( No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,city state,and ZIP code) A-dd r ess of Vacated Homestead,if umber and street.city,state,and ZIP code)
,3:7'2_,.., k e-r„'-i-- 0C.-4-1 6 • 1
ASSESSOR USE ONLY ASSESSED VALUE ( HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately t r
Surrounding Residential Improvement (1} N d "`:
Other Land (2)
Total Land(line 1 plus line 2) (3)
SFF 1 1 2024
Residential Improvements or Dwelling (4) • `
Annually Assessed Mobile f •¢-
Manufactured Home Garage (5)
i€ G.0 (..fie,/,4%- -
Other Improvements (6) GIBSO V COUNTY AUDITOR
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 . .,,,,� Date ned(m nth,day.year)
0 LOa \,3CliAt0_ Y\ • H' - 11 ,,..._X
DISTRIBUT ON: Original-County Auditor,File-Stamped Copy-.Taxpayer
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