Homestead_Schurmeier "'`� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
l � 1 i STANDARD / SUPPLEMENTAL DEDUCTION FORMo 2023
State Form 5473(R19/1-23)
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) Malcolm Schurmeier certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, 11/14/2023 (date of signature).I(We):
0 Own. ❑Am(are)buying under recorded contract.
El 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
Name of Claimant(legal name)
Name of Claimant's Spouse(legal name)
Social Security Number of Claimant's Spouse(last five digits) Driver's License/ •-ntifi umber of Claimant's Spouse(last five digits) Issuing State
(Applicable o•y .pplica ' ouse does not have asoCial security number)
•
CONTRACT REC ED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded P\S ' Record Number Page
PROPERTY I?FSCRIPTION
County Township G\'. Taxing District(city,town,township)
Gson 027 P Township
Parcel Number Legal Description Is the property in question:
0 Real Property ❑Annually Assessed Moue 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.
26-12-18-404-001.740-027
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
0 Yes ❑No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. '
Address of Contact(number and street,city,state,and ZIP code) Address of Vacated Homestead,if any(number and street,city,state,and ZIP code)
312 E 150 S, P'ton, IN 47670 9577 S 350 E, Haub, IN 47639 (26-19-34-200-000.876-024)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I 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/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)