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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Forth 5473 (R121609)
,S Prescribed by the Department of Local Government Finance _
INSTRUCTIONS: See reverse side for filing instructions.
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COUNTY AUDITOR
❑ I (we) own ❑ 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
INFORMATION
Name 91ldaimant (legal name)
Sacral Security of (Asir dgm)
Driver's license I Identification
Name of da'unam's spouse (legal name)
Social Security number of daimanfs spouse (last five digits) Drivers fcense I Identification I Other number
Issuing Stale
of daimam's spouse (last five digits)
CONTRACT ••r r
IL buying on contract, Fee Simple owners name
,
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township Taxnadmirict (city, town, township)
Parcel number
Legal description (/, e/ 'TY? A-
Is the pro
question:
I AJ'E of —
0 Real property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structural or the land not exceedtrg one (1) acre Nat immediately surrounds that structure Is used to practical trrcorne, describe the use and portion
of the pmpedy utilized to produm Income.
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PROPERTY r BY CLAIMANT IN OTHER COUNTIES
County Township County
Township
I hereby certify the above statements are true, corract and complete. y
Signaht t r"a"t
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draw and street, erlystare, and ZlPCOd
�(amber
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
HOMESTEAD NON-RESIDENTIAL
AT 100% OF TTV
I VALUE VALUE
Land not exceeding 1 (one) acre immediately 1
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surrounding residential improvements. ()
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Other land
2
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Total land (line 1 plus line 2)
(3)
Dwelling
(4)
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Residential improvements or Annually
Garage
5
Assessed Mobile I Manufactured Home
Other Improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signal= of Assassar
Data signed (month, day, yea0
and complete.
Veifying action - Syreaue of Auditor
Date signed (month, day, yea)
STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notiumstandirg any other pmvisxon, the sum of the deduabons provided in IC 61.1 -12 to a mobile time that is
$
not assessed as real property or to a manufac rred home that n not assessed as real property may not exceed
or, -hall (12) of the assessed value of the mobile home or manufactured hwne.
Signature of Auditor
Date signed (month. day, year)