Homestead_Baldwin 'Reset Form'
.i,�,' CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD / SUPPLEMENTAL DEDUCTION 7,02)'
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/ State Form 5473(R201 12.24iHC10f'•,
- Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone, Social Secunty, dnver's license state identification and federa. iilentification numbers are confidential under IC 6-1 1-12.37,
CERTIFICATION STATEMENT
gamin
I (We) faMitilla __ II, 01 certify that I (we)occupied as my (our)principal place of
residence or am(are)buyi g the i oll1 g • s nbedproperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed 'L ) (date of signature) I(We)
Chun _-I Am (are) buying under recorded contract
❑ (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the nght to occupy the property under the terms of a qualified personal residence trust
If Buying on Contract. Fee Simple Owner's Name
Recorders Office Where Contract is Rec ec Record Number Page
PROPERTY DESCRIPTION
County Townsh 11111 Taxi istn city wn.township)
()):._- ____SQi\ 1V) ‘e_ -• .
Parcel Number Legal Description - s the property in question
. Real Property ❑ Annually Assessed Mobile Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one 1.1)acre that immediately surr n s that structure is used to produce income.describe the use and portion
of the property utilized to produce income
v."2, 6
- \12L ?- 0bo . % \ - o' 2_2_
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State. County.and Township is Claimant Vacating - Homestead?
Yes ` No '
Signatu •• VI.-- 1 4
I here he above statements are true. correct, and complete i • .1lb. 6.01A)..._
Address of Contact (nu ber and street. city. state, and ZIP code) ddres of Vac-le, uome.stead, if any (nuQlter and street. city state. and ZIP code)
3✓a S 1` c� 1
ASSESSOR USE ONLY j ASSESSED VALUE ! HOMESTEAD VALUE 1 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) .0- ) 16.)
Annually Assessed Mobile I -
Manufactured Home Garage (5)
Other Improvements (6) _`1 i ,�os?N
Total Improvements (Line 4 through Line 6) (7) JC)I
0,, k
Total Value(Line 3 plus Line 7) (8) \ \
Signature of Assessor „1. r `�JflDate Signed(date. month.year)
I hereby certify the above is true, correct, and complete, ro
Verifying Action-Signature of Auditor (-j\� Date Signed (date month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000
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 a manufactured t is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the bile ome or nufactured home
Signatur for r. t .1-� ►e S Daig e \ d yYq�ar)
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DISTRIBUTION: Original-County Auditor. Fite-Stampe opy-.Taxpay
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