Homestead_Pohl e'•'•'r,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
Sji ! STANDARD/SUPPLEMENTAL DEDUCTION FORM
.. State Form 5473 0R18/1-20) HC1O 20 2.-2.
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.
I(We) certify that I(we)occupied as my(our)principal
place of residence o am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
De uction is here aimed on the date this application is signed, (date of signature). I(We):
Own. ❑ Am(are)buying under recorded contract.
m (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.
❑
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township co 2_,..),...__ I Taxing district(city town,township)
Parcel number Legal descriptjo0 �� Is th roperty in question.
/fV\ Real property ❑ 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 sumo its th t structure is used to produce income,describe the use and portion
of the property utilized to produce income
2C— tck - tg - 1o2- 0 ouct39 - d2 _s— -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County and Township Is claimant.- -' g a homestead?
❑ Yes A No
XSign r or lei 'O /
I hereby certify the above statements are true,correct,and complete. n /L
Address of contact(number and street,city.state,and ZIP code) Addr s of vacated homestead.i.`/
any(numb- an.stree.ci y sta-,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) FILED
surrounding residential improvements
Other land (2)
Total land(fine 1 plus line 2) (3)
Residential improvements or Dwelling (4) FEB 1 0 2023
annually assessed mobile/
manufactured home Garage (5) - •
Other improvements _(6) /�-iI e
Total improvements(line 4 through line 6) (7) C R,SO --COUNTVf AUDITOR
Total value (line 3 plus line 7) (5)
I 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 IC 6-1 1-12 to a mobile home $
that is not assessed as real property or to a manufactured h at is not assessed as real property may
not exceed one-half(1/2)of the assessed value of them de horn or ufactured home.
Signature of Auditor Q V Il^^ Date aigne/ (month,da yeah
�fffaVVVJ1) rV- 0 2
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Ta
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