Homestead_Muncy (2) i,9:7 0 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR )
*or) STANDARD/SUPPLEMENTAL DEDUCTION . /l YEAR
l�
/ State Form 5473 R19 I 1-23, HC10 W
(*or)
Prescnbed by the(Department of Local Government Finance 111 x
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Secunty,driver's license.state identification and federal identification numbers are confidential under IC 6-1 1-12-37.
CERTIFICATION STATEMENT
I(We) - certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the fo rieWrgperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
AA
s application is signed,
,(date of signature) I(Wet
n ❑ (are)buying under recorded contract
(are)entitled to occupy as a tenant-stodeholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑Am(are)the shareholder,partner,or member of the entity that owns the property
Social Secunty Number of Claimant's Spouse(last five dryers) 'Dryers License'identification Other Number of Claimants Spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
I
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office✓Were Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County \� Township 0
0\_A\ I Taxing District(city town.township) 0
Oa
Parcel Number 1 ' Legal Description \ , th property in question /`"0
UIs
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)acre that immediately surro ds hat structure is used to produce income describe the use and portion %./"'.9
of the property utilized to produce income I
P)._____ _ rS — \9000D \ . 5lL\ oOk
PROPERTY OWNED ELSEWHERE BY CLAIMANT I
State.County,and Township Is Claima acaMsgp Ho Ci) OYes No U
- Signature or Clamant
I hereby certify the above statements are true correct,and complete • /eet..'.22.
` trAdd-ss of C•ntact number and scree city state and ZiP code) ACCICss of'Vacated Homes ad if any(number andt city.state and ZIP ca"i.
V \ s� -3+� _ ssuo E 1�-r ;_ . — n
ASSESSOR USE CNLY I ASSESSED VALUE 1 HOMESTEAD VALUE 1, NON-RESIDENTIAL VALUE
0
Land Not Exceeding One(1)Acre Immediately (1) 40
Surrounding Residential Improvement
..[--
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential lmprovemen or Dwelling (4) i �
Annually Assessed Mobile I
Manufactured Home Garage (5) /� IAAA
Other Improvements (6) C/e' o
Total Improvements(Line 4 through Line 6) (7) O+C <,O Jv/
Total Value(Line 3 plus Line 7) (8) o�/��.��� ��
Signature of Assessor Date Signed(date mtn)b ye.,-,
I hereby certify the above is true,correct,and complete. ' qG
Verifying Action-Signature of Auditor Date Signed(date month.yesiO 7,
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48 000
NoM.itnstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(112)of the assessed value of the mobile ho ufactured home
Signature of Audi Date S ned(mo h day year)
(Ark
DISTRIBUTION' Original-County a..tluo =de-StampeC:17.`py •
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