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Homestead_Mauck ei/tt* CLAIM FOR HOMESTEAD PROPERTY TAX y STANDARD I SUPPLEMENTAL DEDUCTION FORM State Form 5473(R19/1-23) HC10 �ZR J YEAR '�"�� 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) % ~ 111 G/c I 4- r * ) certify that I(we)occupied as my(our)principal place of residence or am(are)buying the fo li rwin�I ecltscribe real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, 12 I 11�/� (date of signature).I(We): kn. l 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 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 Recorder's Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County ,^ Township IITaxing Distric city,town, w ip> 3-‘ ' Parcel Number Legal Description Is e property in q estion: eat Property 0 Annually Assessed Mobile Home(IC 6-1.1-7) It any portion of the residential structure or the land not exceeding one(1)acre that immediately sum nds at structure is used to produce income,describe the use and portion of the property utilized to produce income. (26...... VS ri- \r'S .--- 1,....‘0 Lk , 000 5 0 5.--..._ 0 2C) PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Clai,ant Vacati g a 'omestead7 es (L No Signet r it, • ,pry I hereby certify the above statements are true,correct,and complete. /� ,�Y/ Address of Contact(nu er and strzia.rt,city`stpte,ar}i�ZII PP—c`o fee) Adrdrres Vacated( Hy estea it any(number and street,city,state,and ZIP code) 49 ASSESSOR USE ONLY ( 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 1 plus line 2) (3) p Residential Improvements or Dwelling (4) . ...6"7 Annually Assessed Mobile/ Manufactured Home Garage (5) Other Improvements (6) Total Improvements(Line 4 through Line 6) (7) (• 1/ ?©2� Total Value(Line 3 plus Line 7) (8) Signature of Assessor �S'OA' Date Signed(date.mo ,year) I hereby certify the above is true,correct,and complete. r'Y'00 /vFV^�2 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 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 home or manufactured home. Signature of Auditor Date Sic red( onth,day,yea() DISTRIBUTION: Original—County Auditor,File-Stamped —Taxpayer i Page 1 of 2 , �/� /�/