Homestead_Lynch (3) /,9:7 � CLAIM FOR HOMESTEAD PROPERTY TAX r YEAR
(1/ STANDARD/SUPPLEMENTAL DEDUCTION FORM
/ State Form 5473(R19/1-23) HC10 a 3
Prescnbed 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) Lhr.4f1l10.. L L. L toGIN _ __ __ _certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following okabcribed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. 1/f 2fa S (date of signature) I(We)
Down ❑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
CLAIMANT'S INFORMATION
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number 1 Page
PROPERTY DESCRIPTION
County G Township Taring District(city,town,township)
bs� 0 1 -P0.ho�- Town k.,P
Parcel Number Legal Description Iss the propertyin question
�f,-i'z-11-MOD-coo. 1O9 Q- Got 7 Vheal 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 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 Vacate Homestead/
gnatµl of Claimant
I hereby certify the above statements are true,correct,and complete Eire-s) _.2�SZ-l.,C,'ztirt�t
Address of Contact(number and street.City state and ZIP code) Address of Vacated Homestead.if any(numbe and street city,state,and ZIP code)
IV; F o ?r: - 47o
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately i 1)
Surrounding Residential Improvement - ,
Other Land i(2) ii TTotal Land(line 1 plus line 2) (3) F L
Ep
Residential Improvements or Dwelling _1(4)
Annually Assessed Mobile I - A
Manufactured Home Garage (5) SEP 12 2023 WOther Improvements (6)
Total Improvements(Line 4 through Line 6) (7) �-17-A rfatil a
nd
Total Value(Line 3 plus Line 7) (8) GIBS ON COUNTY AUDI OR
Signature of Assessor Date Signed(date.month.year)
I hereby certify the above is true,correct,and complete.
Ventying Action-Signature of Auditor Date Signed(date month,year)
STANDARD DEDUCTION ALLOWANCE
•
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48.000
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` l of the mobile home or manufactured home
Signature of Auditor ��LL Date Signed(month,day.year)
itk
PIV
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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