Homestead_Powers (2) 4, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
t� , HC10 2-3,
State Form 5473(R19/1-23)
Prescribed by the Department of Loca':;..rnnment rwar.ce
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. LED
CERTIFICATION STATEMENT
Al..;
I(We) �/ Q/YYt(„eY`+ certify that I(we)occupied as my(our)principal place o
residence o am(are)(ymnhe followin • ,�s al operty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application i signed, I I 1 (date of signature) I(We) N J V 08 2023
tr Own ❑Am(are)buying under recorded contract
0 Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation /1 th ! I/1//_'L
❑Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust I' 'u - - -/ /) LY�.LKI�
❑Am(are)the shareholder,partner,or member of the entity that owns the property 74)
- -LICLCO U NTY AUDITOR
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing Di t(city,town,township)
Parcel Number Legal Description Is the property in question
Ss ad(�( 4, 7 eat Property ❑Annually Assessed Motile Home(IC 6-1 1-7)
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
a6 —! 1 - / €8 - Aa3 -003. A. 03 — v g
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead/
/I 0 Yes Iv
Signa re f laim�it 1'1
I
hereby certify the above statements are true,correct,and complete �►J'J.11 ►�l/i ((V//��(/yy�/
zilit
Address of Conta t(number and street,ay,st.e.and ZIP code) Address of Vaca ed Homestead.if any(number and street city.state.and ZIP coder
22 /Ilb ' g'I i1Y1 1 L4 (w I 4
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 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) 1
Residential Improvements or Dwelling (4) -
Annually Assessed Mobile I -
Manufactured Home Garage (5)
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.
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 648,000
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)iM of the assessed value of the mobile home or manufactured home
Signature of Auditor -- Date Signedft/. '3
day year)
t
•
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-T payer
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