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Homestead_Wayman (2) s. -r... CLAIM FOR HOMESTEAD PROPERTY TAX ai % STANDARD/SUPPLEMENTAL DEDUCTION FORMHC1 /� State Form 5473(R18/1-20) rrr. 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) ( �}.1� Of\IL i �1 certify that I(we)occupied as my(our)principal place of residence or am(- e)buying the folldWing des i ed real propyrty upd $grits o_prhich a Homestead Property Tax Standard Deduction is hereby claime•on the date this application signed, �(� !/�) LJ • (date of signature). I(We): ❑ Own. ❑ Am(are)buying under recorded ntra t- ❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ❑ If buying on contract.Fee Simple owner's name Recorders office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township Q O Taxing.scoot(c .town,to hi-) �\r II ,I � \W Parcel number Legal description Is th •roperty in question • FA Real property LI Annually assessed mobile ome(/C 6-1.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately Burro ds t=t structure is used to produce income,describe the use and portion of the property utilized to produce income . — \y— -2- --a —3©D - 00o 17k -UD PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County.and Township Is claimant vacating a homestead? ❑ Yes ❑ No 1 O Sig 'y��� /J eC ^� I hereby certify the above statements are true,correct,and complete. i//�/7 �� OQG��LAddress of contact(number and street,city state.a d ZIP cod Address acated homestead),04.ittl*e.-2. number and street,city State,and ZIP code) 235o S [2-5 E' o'to CA —,5n 4 -66 v LOOZ s C-k-v.lot i -\31 :On. ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL. VALUE Land not exceeding one(t)acre Immediately (t) j surrounding residential improvements - - Other land (2) _ FILED - - Total land(line 1 plus line 2) (3) - ) 1 Residential improvements or Dwelling (4) ) annually assessed mobile I manufactured home Garage (5) JAN 6 2023 0 Other improvements (6) - (..,-3 Total improvements(line 4 through line 6) (7) /L/,,,. ) Total value (line 3 plus line 7) (6) t"�—� a 1 G Signature or Assessor GIt3SON COUNTY(*rJ�4la(j ttn.day.yeas I hereby certify the above is true,correct, and complete. Verifying action-Signature of Auditor Date signed(month,day,year) O 0 N_ f STANDARD DEDUCTION ALLOWANCE W 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. I 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 h•••_ •-t is not assessed as real property may 6-,not exceed one-half(1/2)of the assessed value of the m•• _ -• manufactured home. Signature of Aud ` \�y�� Date �gnydTm nth day.year) N1 t/^/ �OZ3 I DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Ta •- - Page 1 of 2