Homestead_Johnson (13) ^••4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
/k : STANDARD 1 SUPPLEMENTAL DEDUCTION FORM
- State Form 5473(R1811-20) HC10 a2 3
e• 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.
R CERTIFICATION SJATEMENT
I(We) 13 r-es) i3+r-eri L ._)Dhnso)1 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):
E''Own. ❑ 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.
- - - - -
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- -PROPERTY DESCRIPTION - - ' - - --
County Township Taxing district(city,town,township)
•
(� t1aSDv1 �IGYL aw\er __
Parcel number Legal description Is the prop in question:
a G-h—I eS-1 Dd aD(tj'o — 1 UL,frgevl 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,county.and Township Is claimant vacating a homestead?
❑ Yes (]a..ld6
VISety-'"it(V?
I hereby certify the above statements are true,correct,and complete. -'
Address of contact(number and street,city state,and ZIP code) Address of vaca edhomestead,if number and street,city state,and ZIP code)
Cp'00 5 /(2,5"C>W CD - t,) 117&cp 5
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately ..
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) ,.
annually assessed mobile J
manufactured
ed home Garage (5)
Other improvements (6) FEB 21 2023 f
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor on
and complete. IBSON COUNTY AUDITOR
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 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)
/ a P/491Icc3
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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