Homestead_Prater u" , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
� i‘ STANDARD/SUPPLEMENTAL DEDUCTION FORM --
‘. ,.,' State Form 5473(R19 HC10
Prescribed by the Department o L..cal f
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
(VVe) ` C • r-
• certify that I(we)occupied as my(our)principal place of
residence or am(are)buyi IlowirAdescribed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date,�,/this application is signed, `-Z.-• (date of signature) I(We)
U'Ow�n ❑An(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
❑Am(are)the shareholder,partner,or member of the entity that owns the property
CLAIMANT'S INFORMATION
SCn
CONTRACT RECORDED `/- 6�023
If Buying on Contract.Fee Simple Owner's Name 03 ✓ ,1inr\V
li
Recorder's Office Where Contract�s Recorded Record Number Page SON Ory ee.�
gup,
PROPERTY DESCRIPTION
Corny Township Taxing District(city(own,township)
C-0' b rm . Q A<..rrsQ Ile.
Parcel Number Legal Description Is the property in question
eel Property ❑Annually Assessed Mobie 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
a lQ \-1-`-" ert) - Oaa
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is Claimant Vacati�ng,a Homestead?
❑yes uj�
I Signal re e of Claimant
I hereby certify the above statements are true,correct,and complete. eSnTJ
Address of Contact(numbeer a street ity slate an ZIP co--+� Addre of Vacated Homestead.i ' y(nu •er and st el crry.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 1(2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) - (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date.month.year)
I hereby certify the above is true,correct,and complete.
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 riot
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signature of Auditor 1 Dat�S1e{ied(mon y-7- w
eta—_ra/-\—\tt-(��t �i�C �• ,1� 11`� \„raj. � �`/�
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer �.
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