Homestead_Sertich y CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y.�'%
STANDARD,/
/SUPPLEMENTAL DEDUCTION FORM
L
I State Form 5473 HCIO 7Q22�
Prescribed by the Department of Local Govemment 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.
I(We) ��o c LCXU5V I eo t_// t tc_h certify that I(we)occupied as my(our)principal
place of residence or am re)buying the following described rehl property under contract for which a Homestead Property Tax Standard
Deduction is hereby clai ed on the date this application is signed, (date of signature). I(We):
❑ 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.
El Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owner's name
0 Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
CDJin c 2 9-- -
Parcel number Legal description I theyproperty in question:
r/r/Y�\J1aReal property CI 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 1 t t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2C=\\ ---- 7� k —1.00 0 0\ - .5 'D —02`-9— .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
`, Signature of claimant
I hereby certify the above statements are true,correct,and complete.J(
Address of contact(number and street,city,state,and ZIP code) '\ Address of vacated ho--stead,if any(number and street,city state,and ZIP code)
O,_ G) l'S'°S Q • n- '(1— s m _._ .
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land note Si.gntta o 1)provem acre imentsedmiately (1) •
g - ----- --- --
�O clan (2) I
o fine 1 plus line 2) (3) _
Residential pM'{t� cots or Dwelling (4)
annu�Ily gsb3' obile I -_ -- -- - — -
rz�u ct a home ��) Garage (5)
Other improveme�7/�IIfc ,tCIO) (6)
f�Total Im o p (AN through line 6) (7) _
`45003 plus line 7) (8)
cG,,0 Signature of Assessor Date signed(month,day,year)
Cs hereby certify the above is true,correct.
and complete.
Verifying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
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 home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile anufactured home.
Signature of Autlkonr�t�\ 1 � _ Date si d( n day,year) 2- , .
,b; `v vw �o�el� � z
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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