Homestead_Dever-Reynolds . .
's-i-,,.. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
440tit STANDARD I SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R1S I 1-20) HC:10 -2. 0 23
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone Social Secant,driver's license,stale identification and federal identification numbers are confidential under IC 6-1.1-12•37.
- . CERTIFICATION STATEMENT -
tqf Pr wir
I(We) 1 VNI(V_1 elz.7 a . certify that I(we)occupied as my(our)principal
place of residence or am(are)buying e following describ real property under contract for which a Homestead Property Tax Standard
eduction is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. E Am(are)buying under recorded contract.
m (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
IiI Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
1:1 Am (are)the shareholder, partner, or member of the entity that owns the property.
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.
CONTRACT RECORDED - -
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
—PROPERTY DESCRIPTION ._
County I Township Taxing district city,t ,township)
Parcel numb
Legal description Is e roperty in question:
Real property 0 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 surr nds th structure is used to produce income,describe the use and portion
of the property utilized to pr ace income
41.0
4 T .)-- 0 ZS ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant ,rti :a homestead?
ED Yes j' No
X
Si atur of r ant
I hereby certify the above statements are true,correct,and complete.
„,.,,..4
Address _contact(number air.„et cit r.state.and ZIP••tiCi9._‘, I Address of v rated homestead,if any umber an. treet,i ty,stat-,-nd IP code)
5—3° M 0/1 •
ASSESSOR USE ONLY
I ASSESSED.VALUE HOMESTEAD VALUE NONRESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) - - \! E
'
Er -
Total land(Iine I plus line 2) I(s)
F t D
.i..... . .
Residential improvements or Dwelling (4) ' .
annually assessed mobile I ,.:,
manufactured home Garage (5)
MAR 31. zoz3
Other improvements (6)
Total improvements(line 4 through fine 6) (7)
Total value (line 3 plus line 7) (8) 24C-A4ii a,. (ana)
I hereby certify the above is true,correct, signature of AzGiaS0 N COUNTY AUDITOR 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 provid in -1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home th is no s sed as real property may
not exceed one-half(1/2)of the assessed value of the mobile ho e o menu t red home.
Signature of Auditor sign ( Ili,daY rstro 2..r...1
Yli Date ed i(A)C11/437 -jt--
'Sr
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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