Homestead_Dewig (12) ,•, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
la;a s STANDARD I SUPPLEMENTAL DEDUCTION FORM r .
;l ;) State Form 5473(R19/1-23)
Prescribed by the Department of Local Goveu-^ier-t I n,,cr
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) A"A 4- ae•en A e.r?.q 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
(20
t�eet/this application is signed, 9/N1/013 (date of signature) I(We)
,-
IGOwn ❑Arn(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
. .
CONTRACT RECORDED
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)
G't1P scm d2 ohn son
Parcel Number7er �/• Legal Descriptionc 1 IIsst the
eproperty in question
(94.-1 •f(/)-a00- �a. /�3—oeC� I_fllltalProperty ❑Annually Assessed Mobie Horne(IC 6-t1-7)
If any portion of the residential structure or the land not exceeding one(111)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 V- -ting a •mestead?
❑yes Pi o
Sign. I Claimant
I hereby certify the above statements are true,correct,and complete
Address of Contact(number and street.city.state and ZIP code ••-ess of .c ed No f any(number and street ary.state.and ZIP code)
o 0 0• I a„bs+add i-AJ Li74234k -- .,l . Aaratl // i Cal/6
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately 1 1
Surrounding Residential Improvement
Other Land I(2)
Total Land(line 1 plus line 2) FiL(3) ED
Residential Improvements or Dwelling (4)Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6) SEP 14 2023
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Asses . Date Signed(date month.year)
I hereby certify the above Is true,correct,and complete. f411180N COUNTY AUDITOR
Verifying 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 of the mobile home or manufactured home
Signature of Auditor Date Signed(month.day.year)
AAA., l .1 9-1✓-_-- iMia3
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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