Homestead_Martin CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
I7 n''-4.\tI,\ STANDARD/SUPPLEMENTAL DEDUCTION FORM
., / State Form 5473(R19/1-23) HC111 C2 3
•
• •�� 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.
Ail
STATEMENT
L I(We) 1111R ts \ Gr-h n certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followlig de bb)e_d L7eayroperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dat this application is signed. It( { r-tc_SS_ (date of signature) I(We)
Own ❑Am(are)buying under recorded contract
❑ 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
Social Secunty Number of Claimant's Spouse(last five digits) 1Omers Lcense/Identibwtxm/Other Number of Claimants Spouse(last five diets) Issuing State
(Applicable only it applicant's spouse does rot have a social security number)
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name i 2
Recorder's Office Where Contract is Recorded Record Number Page 0 �O?�
- - I
PROPERTY DESCRIPTION
County SO1r1 C) 2--2-Township ,z .Taxing District(city.town,ton, - % \,1 Ai)), l
Parcel Number Legal Description th property in question V 1 • AO/rO
R
Real Property ❑Annually Assessed Mobile Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately suit ds hat structure is used to produce income.describe the use and portion
of the property utilized to produce income
26- il - 0 1 _ Lkos _ 0
N
Oo s 2 -. --- 022 °�
04
PROPERTY OWNED ELSEWHERE BY CLAIMANT 1
State,County,and Township Is.ai -nt Vacating a Homestead/ W
P1 Yes ❑No 1
Sig l re of CI. ant I
I hereby certify the above statements are true,correct,and complete - r,, ai, A r l 4 ' A ` •
Address of Contact(number knd street city,state.and ZIP code) •ddress of Vacated Homestead.if'ny(number.nd stge4 ctty.state and ZIP code)
SO)'. 'J G_StneilDbt,. I\Awe —51. 2-o6 fa.) c.)J:\1tcy1n. N -r'C
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE ', NON-RESIDENTIAL VALUE O
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) 1,
Total Land(line 1 plus line 2) (3) 'fV7l"
I
Residential Improvements or Dwelling (4) 0
Annually Assessed Mobile/
Manufactured Home Garage (5)
PI
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.
Venfying Acbon-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 6
is not assessed as real property or to a manufactured home that is not assessed as real properly may not
exceed one-half(1/2)of the assessed value of the g
obile home or manufactured home
Signature of Auditorrs� •
(� Dat 1;l ned(mo _day.ygpr/rI YY�I J ` �/ ��Z
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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