Homestead_McCaleb (2) / CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
� e$) State Form 5473(R19/1-23) HC10 7-0
\--,P1r--- 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 Me) . ' i ' ..1 b.&- e 4 C II_ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the f wing descwri.:,. •-al property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date th' plication is signed, 'a'W- _ _ (date of signature) I(We)
Own El Am(are)buying under recorded contract
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑Arn(are)the shareholder,partner,or member of the entity that owns the property
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
l°c ty 1 T ^ Taxi Di t(c.,town,township)
Coy tYJ 1 1\ �C PW ` a
Parcel Number Legal Description Is the property in question
eat Property ❑Annually Assessed Mobile Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(II 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 Vacating a Homestead?
❑yes rb9To .---
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. X ///y"►yam{
Address of Contact(num°°��r ame�nd,street city.state and ZIP rj Address of Vacated Homestea ,if a y(number and street city state.and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately i(.1)
Surrounding Residential Improvement
Other Land (2) M
Total Land(line 1 plus line 2) (3) 4
_ 474(:)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ /h
Manufactured Home Garage (5) /" i
r ��Other Improvements (6) 3
Total Improvements(Line 4 through Line 6) (7) C'esO/V C Q r• -)��
Total Value(Line 3 plus Line 7) (8) CUNTY 1
Signature of Assessor Date Signed(date.month,yea1�/Q ) s
I hereby certify the above is true,correct,and complete. I OR
Venlying 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 rDat Signed(month.day,year)
- -ate ____
d\
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2