Homestead_Gross CLAIM FOR HOMESTEAD PROPERTY TAX YEAR '
10 t\ STANDARD/SUPPLEMENTAL DEDUCTION FORM F -
��/ State Form 5473(R19/1-23)• HC10 a3
i•
�w� 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,
G CERTIFICATION STATEMENT
I(We) 3C. •ley ' r\S4 i(w G. Y O SS certify that I(we)occupied as my(our)principal place of
residence or am(are)bruymg he followln tl�{r ed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
t date application is signed, hi 41 (date of signature) I(We)
Own ❑Am(are)buying under recorded contract
0 Am(are)entitled to occupy as a tenant-stodcholder 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
If Buying on Contract,Fee Simple Owner's Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County , Township ,Taxing District(city town,township)
l.9 ObSro" 02A1 I '3-.knS011
Parcel Number (( Legal Description Is Is the property in question
2 G—a3-1 V — ?O CQp'0 • C.03—C- 9 Real Property 0 Annually Assessed Mobie Home(IC 6-1 1-7) n r�
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 l��
of the property utilized to produce income
N
w
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant V cating a Homestead/
es ❑No (`
Signatyy Claimant �'��- �h� �_
I hereby certify the above statements are true,correct,and complete ( G /1/131-,1-
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) O
16 • LinCokr‘ .C.4e, )4,44 ;r/ 4743g • 410 S a-Yr .g ._. =r/ q7 q Brk& II-
: W
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE 1
Land Not Exceeding One(1)Acre Immediately (1) O
Surrounding Residential Improvement
Other Land (2) 25
Total Land(line 1 plus line 2) (3)
r
Residential b or Dwelling (4) 11E I L E D
Annually Assessed Mobile/ f�
Manufactured Home Garage (5) ` ,„
Other Improvements (6) �O
Total Improvements(Line 4 through Line 6) (7) N 0 V 0 9 2023 +�
Total Value(Line 3 plus Line 7) (8) -C
Signature of Assessor Date Signed Iola nth.year)
I hereby certify the above is true,correct,and complete. ��r�(u. Li(
Verifying Action-Signature of Auditor Date Signed(dal tiPigl!'dr)COUNTY AUDITOR
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 o Au Date Signed(month a year)
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2