Homestead_Shafer 44"'a\ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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STANDARD/SUPPLEMENTAL DEDUCTION FORM3.
•. State Form 5473(R19!1-23) HC10
Prescnbed by the Department of Local Government Finance
INSTRUCTIONS.See reverse side for filing instructions
NOTE:Telephone,Social Security,drivers licens-.state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
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CERTIFICATION STATEMENT
I(We) )rjk Fly certify that I(we)occupied as my(our)principal place of
residen e or am(are).buying the if w g•d�s .-• j ro ty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
Xis application is signed, 1 [ (date of signature) I(We)
n ❑ (are)buying under recorded contract
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
ve 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 G\�yO Page
PROPERTY DESCRIPTION
County SO Township O^ Taxing Distnct(city town.towrtty
Parcel Number Legal Description the roperty in question
Real Property ❑Annually Assessed Mobie Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun that structure is used to produce income,describe the use and portion
of the property utilized to produce income
2-�-- 2 - 10 r UO_0 o,\• c(-I l 02 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is Claimant Vacati • omesteadS
❑yes gi No
Signature of CI man
I hereby certify the above statements are true,correct,and complete
•••ress of Contact( late.anrlie c••e) ` 'Address ofacated Honest tl d any(number and street city,state.and ZIP code)
egg"
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE i 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)
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 548 000
Notwithstanding any other provision,the sum of the deductions ed l IC 6- 1-12 to a mobile home that S
is not assessed as real pro rty or to a manufactured home t s not ass sed real property may not
exceed one- 11/2)of ssess lue of the mobile h (:inufa
lured me
Signature of a Date Sign nth, a 7.0 2,,,, D
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-T aye
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