Homestead_Hallett 1,7", CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(RI8/I-20) HC10
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
1(We) \ 15 Ailarj €.4.4- 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, .r 57 g (date of signature). I(We):
g/6'wn. D Am(are)buying under recorded contract.
0 Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
O Am (are)the shareholder, partner, or member of the entity that owns the property.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County • Township 02, Taxing district(city.town,township)
Parcel number Legal description Is the property in question:
-(-7_ocfr 300- cbo. 61q-od I property 0 Annually assessed mobile home(IC 54 I-7)
If any portion of the residential structure or the land not exceeding one(I)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
Slate,county.and Township Is claimant vacating a homestead?
I:1 Yes a..No
':,@5.81g13_CIV,i'MV..
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street.city.state,and ZIP code) Acittsx,pilfcate•horn. ead.Tf any(numbe•and stri it city,state,and ZIP cede)
C) :3 3 //co 0‘4, itkle '17 9 4111 //
4111NI'
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDETIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) •-•
Other land (2)
Total land lime/plus line 2) (3)
Residential improvements or Dwelling (4) ED
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7) MAY 0 5 2023
Total value (line 3 plus line 7) (0)
&Assessor
I hereby certify the above is true,correct, Signature1,124twieuz ..D4r tibtlikkay,year)
and complete. Y AUDITOR
Verifying action-Signature of Auditor est6SON C It 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)
deVJ ,5/6/? 3
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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