Homestead_Epperson (5) 0 "AD
FORHOM1 ESTEADPRO PERD TAX
STARD I SUPPLEMENTAL DEDUCTION FORM YEAR
11 State Form 5473(R19 l 1.23) HC10 2
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¢c-i-1. -12-:1,. '
CERTIFICATION STATEMENT
I(We) /iiirWrI eli ,.+ ' ! 1 Je...."..Qtrn.•., certify that t(we)occupied as my(our)principal place of
residence or am(ar, buying the folyttji .r-- d eaI o under contract for which a Homestead Property Tax Standard Deduction i94'e-6y�ir�d Q(jt{kA
date this application is signed, VV (date of signature).I(We): 11J111.. II 6l LVL`t'
P�''Own. ❑Am re)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. /� _�1
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust' _G' C,G y ILL+E':424)
❑Am(are)the shareholder,partner,or member of the entity that owns the property, G I B S O N COUNTY AUDITOR
•
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County \.,rr'0 Township dp kit. Taxing'IM'cl(city, can,township)
Parcel Number- Legal Description/A/7)e Al W /Is the property in question:
Mf portionI
( 1 c I heat Property _ -❑Annualty Assessed Mobile Home(IC fi-1.1-7)
If any of the residential structure or the land not exceedingone 't acre um.,.,,,.. mounds that structure is used to produce income,describe the use''nd portion
of the property utilized to produce income.
}, D a, `4-4,
2 6 -22- —kb :- l 00 - 0 02 . 16 L1 - 2_4 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vac:' �;r estead?
❑Yes 7,1 No I
agnalure of Cl.
I hereby certify the above statements are true,correct,and complete. t T/' -1-
dress of Contact(number and street,city,state,and ZIP code) estead,if any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE 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) I
Annually Assessed Mobile/
Manufactured Home Garage (5)
I.
Other Improvements (6)
Total Improvements(Line 4 through Line 6) - (7) I
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
I
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 S
0
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.
Si g%natureofAur1lor41 )e14* ✓/`__jt /g1.
Date jigned(m�o'•nt2,day,year!i 0Yfj 1.4
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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