Homestead_Weiss /,. viaQ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
\`,.• r./ State Form 5473(R1911-23) HC70
Prescribed by the Department of Local Government Finance
INSTRUCTIONS'See reverse side for filing instructions
NOTE.Telephone,Social Secunty,driver's license.state identification and federal identification numbers are confidential under IC 6-1,1-12-37.
CERTIFICATION STATEMENT
I(We) . • MIA I► , certify that I(we)occupied as my(our)principal place of
residence or am(are)buying t -following describe•re.I property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application is signed. (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
❑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
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County J ^v' Township O^ Taxing District(city,town,township)
V v
Parcel Numb Legal Description Is th properly in question
Real Property ❑Annually Assessed Monte Horne(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun rids al structure is used to produce income.describe the use and portion
of the property utilized to produce income
-4DO - OO2 • 1--\°t ) -02�.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacat g a omestead?
❑Yes No
'- Signatur f Claimant
I hereby certify the above statements are true,correct,and complete y
Address of Contact(number and street.city.state and ZIP code) /\Address of V ated Homestead f any iru ber and street city.state.and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (,,
Surrounding Residential Improvement _
Other Land (2)
Total Land(line 1 plus line 2) (3) —FT-L-11 D
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) _ L I A`I77—L7_YU123
Other Improvements (6) �+
Total Improvements(Line 4 through Line 6) (7) fi,``'e 6,2
�y� )
Total Value(Line 3 plus Line 7) (8) GIBSON N v '""""'K✓
Signature of Assessor Date Signed(date,month yearAUDITOR
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 S
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 d home
Signature of Auditor 1 Date Signed onfh.day.year) n ,
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxp
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