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Homestead_Heath "' � CLAIM FOR HOMESTEAD PROPERTY TAX l l; /\ STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR . State Form 5473(R 19/1-23) HCIO 1 \ - 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) Ito V(9k t VI I • certify that I(we)occupied as my(our)principal place of residence or am(are)buying th•follp�J+�i� r I perty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the t this application is signed, ,` _(date of signature) I(We) n Am(are)buying under recorded contract ❑ (are)entitled to occupy as a tenant-stockholder 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 If Buying on Contract,Fee Simple Owner's Name Recorders Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County ��� Township w 2 1 .Taxing District(city town township) Parcel Numb Legal Descnption 1(,y`CRP y in guesu ' Property ❑Annually Assessed Mobie Home(IC&1 1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately sustructure is used to produce income.describe the use and portion of the property utilized to produce income 1 2c \— \ — o o —0 2 —0 2 ( N PROPERTY OWNED ELSEWHERE BY CLAIMANT 1 State,County,and Township Is Claimant Vaca g omestead, lam, ❑Yes No P Si na�W�reof Claimant� //y ��(}���y�I(,�) 1- I hereby certify the above statements are true,correct,and complete /��'' v*'v^"'\ _ \ 1 Address of Contact(number and street.city state and ZIP code) I Address of Vacated Homesteatl f any(number and street.city.state.and ZIP code) (\/ U Cabo Ws She" A•� 'vAc— 1 A . ' T 'c-s-N -o`,\'c. Dv\ 0 ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land Not Exceeding One(1)Acre Immediately (1) '44%) Surrounding Residential Improvement W Other Land (2) IO Total Land(line 1 plus line 2) (3) 1141'..... ..s.":46 Residential Improvements or Dwelling (4) F� Annually Assessed Mobile/ C/�s� Of Manufactured Home Garage (5) Other Improvements (6) tiC�Th �Q<',9 Total Improvements(Line 4 through Line 6) (7) O�tiTy Total Value(Line 3 plus Line 7) (8) 1/G , Signature of Assessor Date Signed(date month.year) 1'• I hereby certify the above is true,correct,and complete. -On Q Venfying Action-Signature of Auditor I 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/C 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(1/2)of the assessed(((''' value of the mobile home or m a e e 3 Signature of Auditor (� v/' Date Si� e�'mo pth,�ay y a/)- ` 1 DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer J Page 1 of 2 • ,kI ;_.l 1. — ,0 t Aael,rCq ©r\ 1�-L I2 1 I `224c I c,,4 [ Page - - M eA, t�a,,Q h Dul,c g. 3 7,3 no S—aQ jlC/r` 1,3 n0fi +si7le_ct - S^c sac z 4— • 01 CC_ f IS i'W (�D e10 % �� n1 th e w�'CI c "C i — "A-- Ce -t`t� elec�,c...kc in 1l(s oil. 206 �C 3 •