Homestead_Zimmerman CLAIM FOR HOMESTEAD PROPERTY TAX
FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION HCfg ZO r,
;,/ State Form 5473(R19/1-23) k •
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) 4 e Is , 1nY Mey/1 _ -_. _ certify that I(we)occupied as my(our)principal place of
residence or am(are buying the follow//''ra*��fr real r rty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
X
is application is signed, 1 I/v O ��Q (Ole of signature) I(We)
n ❑Am(are)buying under recorded contract
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 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
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County 1V Township Q .Taxing District(city,town.township)
jai (`n ' 1
Parcel Number J Legal Description Is .�•operty in question
Ig R'-I Property 0 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 sun• nds that tructure is used to produce income,describe the use and portion
of the property utilized to produce income
2 6. - 12--0 7 ,- 3 0 - 0 03 F 2-02.5 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati omeslead?
❑yes No
Sr/^ 'laimant
I hereby certify the above statements are true,correct,and complete
....._.--
Address of Contact(number and street, state7ndt21P code) I Address of Vacated Home/fk1yerxsrwerntysra(eandZlPCode)code)
e• \ M /IU� `
ASSESSOR USE ONLY ASSESSED
VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement • _ _---- 1,..44-'
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) NO
Annually Assessed Mobile/
Manufactured Home Garage (5) 0f VVV
Other Improvements (6) co?
�
Total Improvements(Line 4 through Line 6) (7) 0/,C J
tiny y
Cc......
Total Value(Line 3 plus Line 7) (8) •Q 7
Signature of Assessor 'Date Signed(date man
I hereby certify the above Is true,correct,and complete. OjQ
Verifying Action-Signature of Auditor iDate Signed(date.month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 648,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home that $
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 IIJ
Signature of Auditor ,/y\o/r/w I Datetried/m%mp�d ear) n
C• l D/ r/v
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
0