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Homestead_Adams (9)
i" \t CLAIM FOR HOMESTEAD PROPERTY TAX __YEAR YEAR /a FORM ,_�� STANDARD I SUPPLEMENTAL DEDUCTION HC10 C-1 J / State Form 5473(R19/1-23) tai:/ Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructionPhanc__. NOTE:Telephone,Social Security,driver's license.state identification and federal identification numbers are confidential under IC 6-1.1-12-37. CERTIFICATION STATEMENT e I(We) .I W N M U i t awe)occupied as my(our)principal place of residence or am(are)buying the following described real property un - !r—614 contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed 1+ 1l a1 (date of signature) I(We) Q'� Am(are)b 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 ED Recorder's Office Vvhere Contract is Recorded Record Number Page SEP 1- 27 ?0?3 PROPERTY DESCRIPTION /y'�,/'�, nship �� Taxing District(city,town,township) I Coxxty / l�'ilnsn fl P4AQlc d aLA[.(0:10 �escm,•c r'`f a� Parcel Number Legal DesaIp'.on Is me property In question Y AOh s. Property El Assessed Mobie Home(IC 6-1 1-7) )TO� ear 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 .o — \ — r-- —c© — tea. Ljl -Cal PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County,and Township Is Claimant Vacating a Homestead? ❑ues Si nature of Claimant q I hereby certify the above statements are true,correct,and complete �[ I�t+�`'/��- a/) n/ Address of Contact(number and street.city.state.and AP code) Address f Vacated Home read.if an, "ber and street city.sla and ZI coder 2710 C,PrC►7lia:eel af.�rinGC-Or►1 /N U1fr7o t ---1 Pl ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land Not Exceeding One(1)Acre Immediately (1) Surrounding Residential Improvement Other Land (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 I 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 arty 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 lame Signature of Auditor Date Signed( nth.day.year) 11....C... 4aDISTRIBUTI N: Original-County Auditor.File-Stampetl Copy-Taxpayer )�.Page f of T