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Homestead_Denbo
e . 9} CLAIM FOR HOMESTEAD PROPERTY TAX YEAR Id. STANDARD/SUPPLEMENTAL DEDUCTION FORM HC10 V-, State Form 5473(R19/1-23) 7l 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 IC 6-1.1-12-37. CERTIFICATION STATEMENT I(We) Q. CC(t.Z P, Ps certify that I(we)occupied as my(our)principal place of residence or arli a e buying the f ..i�}5.Qe d-ry¢I eroperty under contract for which a Homestead Properly Tax Standard Deduction is hereby claimed on the ate his application is signed, !. ) e-- ' . (date of signature).I(We): Own. ❑Am(are)buying under recorded contract. ❑NNNNnnnn(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 leans of a qualified personal residence trust. ❑Am(are)the shareholder,partner,or member of the entity that owns the property. Recorder's Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County Township Taxing District(city,town,fownshr) Q.)I-..I f, Parcel Num rt..... V Legal Description - Is property in question: Real Property ❑Annualty Assessed Mobile Home(IC e-1.1.7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun nd that structure Is used to produce income,describe the use and portion of the property utilized to produce Income. �r12 -off - � _ � _2-- o 0 00. �l 02 PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacatin"Homestead? ❑Yes II No ignature of Clai•- I hereby certify the above statements are true,correct,and complete. 11 0li 1r ), ) r Addr-. • Contact fin b ran• treat,city,state..dnd ZIP . •rid- of omeslead,if any(number an s et,city,state,and ZIP code) al 6 ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land Not Exceeding One(1)Acre Immedlatety (1) Surrounding Residential improvement Other Land (2) Total Land(line 1 plus line 2) (3) Residential Improvements or Dwelling (4) ILE Annually Assessed Mobile/ Manufactured Home Garage (5) Other Improvements (6) JAL 2 3 )' Total Improvements(Line 4 through Line 6) (7) Total Value(Line 3 plus Line 7) (6) G)eS° r�"...J.,/Signature of Assessor N COUNT'r q Si ed(date,month.year) I hereby certify the above is true,correct,and complete. (l©a.O R Verifying Action-Signature of 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 to a mobile home that $ Is not assessed as real property or to. nufactured home that is not assessed as real property may not exceed one-half(1/2)of the asse - -ire mobile home or manufactured home. Sign ure f A ' Da d h, ,ye rL 2 DISTRIBUTION:Original-County Audit•, ••-Stamped Copy-Taxpayer Page 1 of 2