Homestead_White (2) - ..s—;•.4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A , STANDARD I SUPPLEMENTAL DEDUCTION FORM
' M State Farm 5473(R1811.20) HC10 c� _,
L 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) I G(/C/ - '^1 a. fir- certify that I(we)occu•', as!tty r ur)•r(ci•.I
place of•-sidence or am(are)buying the followi described real property under contract for which a Homest--a Pro erty: :n.ar•
Deduction is hereby claimed on the date this application is signed, (date of signature) I(We):
El Am 0'Own. Am(are)buying under recorded contract. MAY 0 8 2023
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 tru t.
❑ Am (are) the shareholder, partner, or member of the entity that owns the property, 1j
-
,_,_ _
If buying on contract.Fee Simple owner's name
1
1 Recorder's office where contract is recorded Record number I Page
1
PROPERTY DESCRIPTION
County `\^) Township 02 Taxing district(city tow township)
3 - i=
I Parcel number egal description I Is the prope y in question
rp QN-3 •~ems-/4c
eel property ❑Annually assessed mobile home(IC 6-1 1.7)
it 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
4 . 18 - d' - aoy - 000. 5 30 - 001.6
i
PROPERTY'OWNED ELSEWHERE BY CLAIMANT
State.county and Township Is« ' vacating a homestead?
`i Yes ❑ No
'Signature of claimant
I hereby certify the above statements are true,correct,and complete. ~,( , }' //
Address of contact(number and street.city state.and ZIP code) rl Add s of vacated homestead.if arty(number and street,city. to�.. -.ZIP code)
7� u� ;00 y -•� f I7s y .� �7A • 1 1
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (t) ' .
surrounding residential improvements
I Other land (2)
I Total land(line 1 plus line 2) I(3) I
Residential improvements or Dwelling I(4) I
annually assessed mobile!
manufactured home Garage I(5) I -
Other improvements I(6)
Total improvements(line 4 through line 6) I(7) I
Total value (line 3 plus line 7) I(8) 1
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 al the homestead or$45,000.
r
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe 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(I/O)of fhe assessed
JJvalue of mobilethe
^
il home or manufactured home.
Signature of Audi ,....„4„..„,..„
.... "•- u ` n nth. V/
Date sig (mo year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-�Ta�xpayer �j ,, �, �j -Qs.
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