Homestead_McIntosh (2) .� CLAIM FOR HOMESTEAD PROPERTY TAX
1 STANDARD 1 SUPPLEMENTAL DEDUCTION FORM
Slate Form 5473(R18/1-20) HC10 _
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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.
�A .--tr-- CERTIFICATION STATEMENT
a I(We) >Vr\[1 Q. t%. 1.hA—C1 . certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real prope under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, I 1 7—.10ZZ.(date of signature). I(We):
can. ❑ 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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
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Social Security number of claimant's spouse(last live digits) Driver's license/Identification/Other number of claimant's spouse(last fi.di•ts) Issuing Stale(Applicable only if applicant's spouse does not have a social security numbe ' 20 22
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name OUN
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
axi
C n Township T district(city town,township)
ea�.NAG.Sper P r #mr-t r caP A-or1
Parcel number Legal description Is the,, property in question:
I�Reel properly ❑ Annually assessed mobile home(/C 6-f.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure Is used to produce income,describe the use and portion
of the property utilized to produce income.
Z.C. ♦—o0oe0 QQ.9'
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County and Township Is claimant vacatinggaa homestead?
El �Yes fvo
Signet ftimant
I hereby certify the above statements are true,correct,and complete. ;/ I
Address of contact(number and street.city state.and ZIP code) Address of vacated homestead,if any(n mber and street,city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/ -- ---
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
1 hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
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 lC 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 signed(month,day year)
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DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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