Homestead_Schmitt (9) 4. rt CLAIM FOR HOMESTEAD PROPERTY TAX
r_ YEAR
� \ STANDARD I SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R 19/1-23) HC10 Z 3
.:/ Prescnbed 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) \�e�� /�11w1 S c NIA\ o certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract to'.:• :h a Homestead Property Tax Standard Deduction is hereby claimed on the
date� this application is signed. ‘‘(t�(73 (date of signature) I(We)
R.J'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
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taring District(city.town.township)
G•
s0')OV1 v - 7,0.4r11'Oh
Parcel Number Legal Descnption Is the property in question
a(,-aO-1L(-Joo- 001.100-pb( ealProperty ❑Annually Assessed Mobde Home(IC 6-11-7)
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
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacatingr aHomfstead9
ID Yes t./lNo
Signa 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 Homes ad if any(number and street cry state and ZIP code)
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) FP 1
Residential Improvements or Dwelling (4) E
Annually Assessed Mobile/ - - -
Manufactured Home Garage (5) NOV I 3 202
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) �j ,`
Total Value(Line 3 plus Line 7) (8) / / 0 _ P6-1, n,a)
Signature of Assessor I Date Slgn9dl Bdate.mnolntR' NTY AUDITOR
I hereby certify the above is true,correct,and complete.
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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 S48.000
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 or manufactured home
Signature of Auditor / Date Signed(month,day year)
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DISTRIBUTION: On al-County Auditor File-Stamped Copy-Taxpayer
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