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HomeMy WebLinkAboutHomestead_Green !7 .''�� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR, STANDARD/SUPPLEMENTAL DEDUCTION HC10 f / State Form 5473(R19/1-23) LilS-i 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(We) - 1 T r � certify that I(we)occupied as my(our)principal place of residence or am(are)buying t e f.lowing.escnbed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, _(date of signature) I(We) ❑Own ❑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 If Buying on Contract.Fee Simple Owner's Name Recorder's Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County ./1✓O Township �, ' I Taxing District(city,town.township) Parcel Number Legal Description (//'[v) Is ropeny in question Real Property ❑Annually Assessed Mobile Hare(IC tit 1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately s mbun at structure is used to produce income.describe the use and portion of the property utilized to produce income (2......0•••••• 04.1 2...1 L JO(4 .._._ ©OO . 1 - 02,D . PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County,and Township Is Claimant Vaca g a omestead7 ❑Yes No�/� /��J /�// I hereby certify the above statements are true.correct.and complete A Address of Contact(number and Street,city.slate and ZIP code) m _2~adtlre. of • if any tuber an sheet city.state and ZIP code) 1O• C' ,r\e 1'1— , . ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE • Land Not Exceeding One(1)Acre Immediately i t) Surrounding Residential Improvement _ — Other Land (2) Total Land(line 1 plus line 2) (3) F, Residential Improvements or Dwelling (4) FILE P Annually Assessed Mobile I Manufactured Home Garage (5) ((�� Other Improvements (6) OCT 4 -_, Total Improvements(Line 4 through Line 6) (7) Total Value(Line 3 plus Line 7) (8) ‘th„..hiLd a J/Y Signature c N COUN I'V AUDITOR 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 548,000 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 assess-. - real property may not exceed one-half(1/2)of the assessed value of the mobile home or manuf. Signature of Auditor Date Sign (m nth.d yea ^ (1r)W 01/4.t4 1\ ....._3 • DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer v Page 1 of 2