Homestead_Helsley Reset;Form
CLAIM FOR HOMESTEAD PROPERTY TAX
}AI:: STANDARD/SUPPLEMENTAL DEDUCTION FORM
.,- State Form 5473(R20/12-24) HC1D I ,�
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Ming 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) m1 C�e %l e Q,(5 1 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real props r contract for which a Homestead Properly Tax Standard Deduction is hereby claimed on the
date this application Is signed, ,•17" (date of signature).I(We):
❑R:Cn. 0 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.
CLAIMANT'S INFORMATION
Name of Claimant(legal name) T hone Number of Claimant Email Address
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Social Security umber of Claimant(lest five di5NyJ Dnve ense dentificallon I OUHr Number of Claimant(last five digits) Issuing State
fr 1 O (Applicable only if applicant does not have a social security number)
Name of Claimant's Spouse(legal name)
Social Security Number of Claimant's Spouse(last rive digits) -Driver&license I Identification I Other Number of Claimants Spouse(last tue digits) Issuing State
(Applicable only H applicants spouse does not have a social security number)
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Tovastilp Taxing District(city,town,township)
Parcel Number Legal Description Is the property in question:
eel Property ❑Annually Assessed Mobile Home(IC 6-1.1-7)
if any portion of the residential structure or the land not exceeding one(1)acre that Immediately surrounds Thal structure is used to produce Income,describe the use and portion
of the property utilized to produce Income.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township - Is Claimant Vacating a Homestead?
es ❑No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. ^,,, r,f I
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Address of Cont.•(number end street,city,state,an ZIP LP code) Address of acal Homestead,itt any(number en treat,city,state,and ZIP code)
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ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE f I,,
Land Not Exceeding One(1)Acre Immediately (1)
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Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2)
Residential Improvements or Dwelling FILE.,1D
Annually Assessed Mobile I
Manufactured Home Garage (5) ' ,
Other Improvements (6) 1 7 2025
Total Improvements(Line 4 through Line 6) (7) JULv •
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Total Value(Line 3 plus Line 7) (8)l
1g�1�`t..(/. Date Signed(date,month,year) F i.,fy". lJ
I hereby certify the above Is true,correct,and complete. GIBSON COUNTY AUDITOR
0-4"\ALtLO Verifying Action-Signature of Auditor Dale 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 JD tsjhor Date Signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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