Homestead_Roberts (8) e t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
't\ STANDARD!SUPPLEMENTAL DEDUCTION FORM 03 A__%.7C.,...i.s.thci).
1 � State Form 5473(R19/1-23) HC10
��� Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. n
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. / 0' )V\-
CERTIFICATION STATEMENT � n .---d
I(We) ♦ `te I O -e S certify that I(we)occupied as my(our)principal place of f 1 Y
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the I.
date this application is signed. IN/2.01/2A (date of signature) I(We)
Gilt< ❑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 Recce Number page
PROPERTY DESCRIPTION
County Township I Taxing Distnct(city.town,township)
6Ib5on OZl / otri olrv►er
Parcel Number Legal Description Is the pro rty in question
b- I'.-3 a-9 b0--70• -75 8- 19a` Di<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 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/
cIt4 ❑No
'Signature^of Claimant /
I hereby certify the above statements are true,correct,and complete 1 '/. —�
,7/.--
Address of Contact(number and street.city,state,and ZIP code) ,Address of Vacated Homestead,rf •er and street.pry,state.and •de) Illll 1 9PYe55 yso u Oviersv% to 1-N K 7 G 6S ___ -- .nz —
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAU VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) }1
Surrounding Residential Improvement _ �/
Other Land (2)Total Land(line 1 plus line 2) (3) F I111._.i11 ' hI)Residential Improvements or Dwelling (4) t/
Annually Assessed Mobile I \
‘.\
Manufactured Home Garage (5) 2023
NOV 2 9
Other Improvements (6) yh
Total Improvements(Line 4 through Line 6) (7) a ,/ r
Total Value(Line 3 plus Line 7) (8) Bp N COUNTY AUDITOR
of Assessor ®1®O®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$48 000
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 f Auditor Date Signed(month.day.year)
, � -2Y NrP9/a 3
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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