Homestead_Dilbeck (3) i' >, V CLAIM FOR HOMESTEAD PROPERTY TAX
a? _) STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR
l•4 ,R, .:,,+ State Form 5473(R1 s 11.23) HC10
\`-""� 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 '
t(We)':JoslidatAindeef:Diibeck'; ^: g;') certify that I(we)occupied as my(our)principal place of
residence or ant(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, 10.16.2024 (date of signature).I(We):
El 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.
0 Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing District(city,town,township)
C'son 021 Montgomery
Parcel Number Legal Description Is the property In question:
Q Real Property ❑Annuaty Assessed Motile Honor(IC 8-1.1 7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26-10-33-200-000.092-021
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
0 Yes 0 No
5rgnatured Ctaigtan'
I hereby certify the above statements are true,correct,and complete. -• t;�~ L.-
Address of Contact(number and street,city,state,and ZIP code ad,it44A(1 dress`af Vacated Homestead,if any(numhe d sity state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement _
Other land (2) ?=
Total Land(line 9 plus line 2) (3)
Fit
Residential improvements or Dwelling (4)
Annually Assessed Mobile/ (:
Manufactured Home Garage (5) W-r).
Other Improvements (6)
OAT
Total improvements(Line 4 through Line 6) (7) , rt1
Total Value(Line 3 plus Line 7) (B) Qo/ (' "�
Signature of Assessor-'00 `-',"...re Dale Signed(date,month,year)
I hereby certify the above Is true,correct,and complete. IV CA.
'4/
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 toe mobile home that $
is not assessed as real property or to a manufactured home that is not assessed as real properly may not
exceed one-half(1/2)of the assessed value of the mobile home or actured home.
Signature of Auditor , /1 � ` Dale�'1v,$igtre ay,year)
atk
DISTRIBUTION: Original�-County Auditor,File-Stam-pped�Copy-.Taupe 2
Page 1 or 2