Homestead_Ford a% t' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• ' - k STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R19/1-23) HG10
•
� s ;4. State
by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fill •ir:-ctaml'ons.
NOTE:Telephone,Social Securi •nver's license,sta-'•entification and federal identification numbers are confidential under IC 6-1.1-12-37.
� CERTIFICATION STATEMENT
I(We) . O i.`=if����. a c CIG `•ten/certity that I(weyoccupied as my(our)principal place of
residence or am(are)buyin• e o oVvmy aeswrueo re-)property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
ate is application is sign:-•, (date of signature).I(We):
n. 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 on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
Cou\LlN N ✓ .Township 0 OPERTY DESCRIPTION
Taxing District(city,city,town,township)
Parcel Number
Description Is t property in question:
Real Property ❑Annually Accxsed Mobile Home(IC 6-1.1.7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sure n s that structure is used re produce income,describe the use and portion
of the property utilized to produce Income.
b 2:-- g -000
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacate t .Homestead?
❑yes •It No
'igna r • lalmant
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,city, e,and ZiRacy_ Address of V omestead,if any( tuber a street,city,state,and ZIP code)'ton-arl
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)
TotalL
line
plus
2
siennd I 1 ine (3) I.-/
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6) MAR
Total Improvements(Line 4 through Line 6) (7) I�h111\ 1 7 ��� \\
Total Value(Line 3 plus Line 7) (8) \
,c.)\
Signature of Assessor 4/ j � W. ,f Y1 et6.4140Dattee Signed(date,month,year)
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor GIBSON COUNTY 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 toe mobile home that $
is not assessed as real property or to a manufactured home t assessed as real property may not
exceed one-half(112)of the assessed value of the mobile h - -cturecf home. r
Signature of Auditor--• (gr_ /", Date SiSigne¢ thi d yea!)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Ta
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