Homestead_Bunze acr4 k CLAIM FOR HOMESTEAD PROPERTY iiiii=ii
o.j,•'1 STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1911-23) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Secudty,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
4 7 CERTIFICATION STATEMENT
I(We)_ lit II ' r" so I (' 1,,112 C certify that I(we)occupied as my(our)principal place of
residence or am(are)buyin.the following described rea rooperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dal is application is signed, _(date of signature).I(We):
Own. ❑Am(are)buying under recorded contract.
❑ (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,
CI Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County LSOC\ Township CD^ Taxing District(pty�o ,tvpr ownship) -
Parcel Na er Legal Description !� I I th operty in question:
sal Property ❑Annually Assessed Mobio Home(IC 6.1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately sun nds at structure is used to produce income,describe the use and portion
of the property utilized to produce income, lo j�j
2
'---a,.:-- 01--
4/ PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vaca n a Homestead?
❑Yes No
Si afore o laimanl
I hereby certify the above statements are true,correct,and complete.
Address of Contact(numbers treat,rah ate,and ZIP code) Address of Vacat d omestead,if any(number and street.ci ,state,and ZIP code)
Ft (e V •
ASSESSOR USE ONLY ASSESSED VALUE I 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 I ,
Manufactured Home Garage (5)
Other Improvements (6) ,Iep 0,' 2O25{.Total Improvements(Line 4 through Line 6). (7)
Total Value(Line 3 plus Line 7) (8) ,
Signature of Assessor GIBSON COUNTa.Y gigned(date,month,year)
I hereby certify the above is true,correct,and complete. ITOR
Verifying Action—Signature of Auditor -Date Signed(dale,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(1l2)of the assessed value} of the mobile home ma actured home.
Signature o�l t Date Signs (mantt� year) 2 -
Vt, / (jc7 Ji ��
DISTRIBUTION:Original—County Auditor,File-Stamped Cop T /
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