Homestead_Bush (2) j
CLAIM FOR HOMESTEAD PROPERTY TAXSTANDARD/SUPPLEMENTAL DEDUCTION FORMr YEAR
State Form 5473(R19/1-23) HC10 ��
�T/ Prescnbed by the Department of Local Govemment Finance ���'�111
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) Al/�. / _7"x07 ' certify that I(we)occupied as my(our)principal place of
residence or am(are)buying e following,dessc l' "/,
d real operty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t . plicatlon is signed, I i 7 / (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.
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑Arn(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 Township Taxing Distnc (city town township)
b 5 Z5n. /fiat/go/niy ✓I ern er-t,/ 01-\
Parcel Number Legal Description Is the prope i uestion
ZIP"II -3 t) 06'5- 5gS- p 2/ Real Property " ❑Annually Assessed Mobile Hare(IC 611-7)
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 Vacating a Homestead'/
❑Yes ❑No
-I Signature of aimant
I hereby certify the above statements are true.correct,and complete
Addressof Contact(numberO and street cal),state and ZI code), ' - A dress of Vaca Homestead.aJitt any(number and street city.state.and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE ' NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)Residential Improvement ( )
Other Land (2) !
Total Land(line 1 plus line 2) (3) 0
r°1:17.11) O
Residential Improvements or Dwelling (4) N •40
Annually Assessed Mobile/ — r',
Manufactured Home Garage (5) W
N Q
Other Improvements (6) C >
O t�`Z
Total Improvements(Line 4 through Line 6) (7) /111.1.14 �"O
Total Value(Line 3 plus Line 7) (6) r� Z U
Signature of Assessor j Date Signed(date.month.year) 1 T Z
I hereby certify the above is true,correct,and complete. rW_
i CO
Verifying Action-Signature of Auditor I 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 or manufactured home
Si nature Auditor ,� Date Signe (mont.day year)
— �l � t� il S-_ - 9_ 2 Z
DISTRIBUTION: Original-County Auditor File-Stamped Copy 6•aver 1
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