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Homestead_Barrett CLAIM FOR HOMESTEAD PROPERTY TAX I FORM YEAR ) STANDARD/SUPPLEMENTAL DEDUCTION HCIO 2022 State Form 5473(Rf 8!1-20) ~ 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) Barrett.Trevin Oneal certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): 121 Own. ❑ Am(are)buying under recorded contract. El 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. CLAIMANT'S INFORMATION , CONTRACT RECORDED It buying on centred.Fee Simple owner's name Recorder's office where contract is recorded I Record number Page \��(✓\(, <,PROPERTY DESCRIPTION County Township V V Taxing district(cif oWn.town rp) e G: b so t. ? Is the property In question: ` • Parcel number Legal descriptionI ©Real property El Annually assessed mobile home(IC 6-1.1-7) If any portion of the residential structure or the land not exceeding one(1)am that immediately surrounds that structure is used to produce income.describe the use and portion of the property utilized to produce income. 26-13-21-100-001.837-004 PROPERTY OWNED ELSEWHERE BY CLAIMANT Is claimant vacating a homestead? State.Courtly.and Township Is Yes El No Signature of claimant I hereby certify the above statements are true,correct,and complete. A.G.A.,1./T 6vleC''� Address of contact(number and sheet,city,state.and ZIP code) Address of vacated homestead,if any(number and sheet.city,state.and ZIP code) 7846 E SR 64,Francisco,IN 47649 NON-RESIDENTIAL ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VALUE Lend not exceeding one(1)acre Immediately • • I ;�_ surrounding residential improvements _._._ __ Other land --- I Total land(line 1 plus flee 2) - t == -- 1111 r Residential improvements or Dwelling (4) annually assessed mobile! (6) manufactured homeGara „Pil � i1' , . Other Improvements (6) Y AUDIT Total Improvements(IIM 4 through line 6) (7) Total value(line 3 plus gee 7) (8) GIB'.ON COON Date signed(month,day,year) Signature of Assess« 1 hereby eer8fy the above Is true,correct, and complete. Date signed(month,day,yea) Verifying action-Signature of Auditor 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 e , ' home or manufactured home. air (rriorrdi. signSignatureaada« ^ ,�, ^ � 1 '2 Date ( 2 DISTrueunoN:Original-County Audit« .Fite-Stamped Copy-Taxpayer Page 1 of 2 L