Homestead_Mason (7)•
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM
e_ .,,. STANDARD/SUPPLEMENTAL DEDUCTION OR
x• i' State Form 5673(R15/S14)
t Presumed by the Oeparbnert of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions,
NOTE:Telephone,Social Security,driver's license,slate identification and federal identification numbers are confidentia n.:r 6-'1-12-3 _
1yYJ1} : t. _se —.s s.,tTi7: x _?•=C :PROPERTY,DESCRIPTION ,.:.-.it' = mot+. era,
County Township Taxing disvia(any,torn,township)
�
Parcel number a description oat? Is the prw ray in question:
00 1 J 1 4 -o t? Real property ❑ Annually assessed mobee home(IC bt.1-l)
d any cordon of the resaeKial st-nsa or the land M exceeding one(1)acre that inu edately surrounds that strut is used to produce income,describe tie use and pore n
of tie property utilized to produce income.
, PROPERTY OWNED ELSEWHERE BY CLAIMANT
Save,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street r2y,Kate,and ZIP code) I Address of vacated homestead,d any(number and street oty,rase.end LP code)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage 1(5)
Other improvements (6)
Total improvements(line 4 through line 6) (7) I
Total value (line 3 plus line 7) (6) I
I hereby certify the above is true,correct, Signature of Assessor Dare signed(month,day,year)
and complete.
VerSig action-Signature d Auc,:nr Dale signed(month.day,year)
r.r ,nit_ 'tr =-"W 7'`' _-. y STANDARD,DEOUCTION ALLOWANCE�f. T' -=_-r- `.--We4'7`TY Spa
20 pay 20 Lesser of 60%of the assessed value of the homestead or$65,000
Nohsithstanding any other provision,the sum of the deductions provided in IC 64.1-12 to a mobile home S
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceed ne-ha the rise value of the mobile home or manufactured frame.
Signature of Date signed(=Mb.daYYear)r'../J r 06
DISTRIBUTION:Ongnal-County Aad_or,FieSamped Copy-Taxpayer