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Homestead_Evans '"'�`��''� CLAIM FOR HOMESTEAD PROPERTY TAX i do .\ STANDARD/SUPPLEMENTAL DEDUCTION FORM r YEAR State Form 5473(R19/1-23) HC10 Z©G�3 Prescnbed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructions NOTE:Telephone,Social Secu- ,,: 'i ". :r •i feder.+ jumbers are confidential under IC 6-1.1-12-37. /p CERTIFICATION STATEMENT I(We) , VA e v knS. • certify that I(we)occupied as my(our)principal place of residence or am free) the following d scribed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed. ice.- ...... (date of signature) I(We) [Q-0wn ❑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 If Buying on Contract,Fee Simple Owners Name Recorders Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION C y Township Taxing District(city.town.township) Ym_2► -(- C \I .( (le Parcel Number Leg Description Is the property in question LJ Real Property ❑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 Vacate a Homestead' ❑Yes y2I No Signature of .t I hereby certify the above statements are true,correct,and complete L.s' Address of Contact(number and street,city state and ZIP code) Address of Vac ted omestead.if any,number and street city,state.and ZIP codel - A © ,t_`te • ASSESSOR USE ONLY ASSESSED VALUE I 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) ResidentialnallyImprovementsMoilor Dwelling (4) Annually Assessed Mobile I D�C ..44e) Manufactured Home Garage (5) O Other Improvements (6) t7 AD Total Improvements(Line 4 through Line 6) (7) SO�C^ �� �0e3 Total Value(Line 3 plus Line 7) (8) 4•46s V c3 Signature of Assessor Date Signed(date.month.year) role.„ . v I hereby certify the above Is true,correct,and complete. e)/TO�y¢-/ Venrymg Acton-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 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 Signa of Auditor � --- I Date Sign�(mynth.3 •-•year) \an4 \�.`_•._ I Via) �3 DISTRIBUT N: Original-County Auditor.File-Stamped Copy-Taxpayer Page 1 of 2