Homestead_Franklin ,- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
I"' ' STANDARD/SUPPLEMENTAL DEDUCTION FORM --- R _,
./ State Form 5473(R 19/1-23) HC10 , L I L1.�J(.71
'•l?/ Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE. Telephone,Social Security,drivers license.state identification and federal identification numbers are confidential under IC 6-1 1-12.37.
CERTIFICATION STATEMENT
I(We) 411127M s •► ' n k, , ►/\ _certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following describetd rye I roperty under contract for which altolinestead Property Tax Standard Deduction is hereby claimed on the h J'1
date this application is signed, l�`\ - t� (date of signature) I(We) O_I/J �.,,.�jO
vn ❑Am(are)buying under recorded contract 1-1
❑Am(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
CLAIMANT'S INFORMATION
If Buying on Contract,Fee Simple Owner's Nan'e
Recorder s Office Vvhere Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Co my Towns p Taxing istnct(city town.to ns ip)
Q.
t\P • Ct`z4 Or . �7��
Parce Number Legal Description Is the property in question
Uiterai;ropeqy ❑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
N^E's�� 10�.1_.1 1 d_ ►� (/may
ath-1
- ci.-to -coo. c-_) -
01
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT 1
State,County,and Township Is Claimant Vacatingg,a H/om lead'
0 Yes (j�1Vo
Signature lamant ///��/ ,,r�
I hereby certify the above statements are true,correct,and complete ' AC � r y' r v 1'�
Address of Contact number and stye .city state and ZIP code) "Addr ss of Vacated Homestead. any(number and street.city,state and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE ', NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement FitED
Other Land (2) T Total Land(line 1 plus line 2) (3)Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) DEL,
Other Improvements (6) Z0�3
Total Improvements(Line 4 through Line 6) (7) G/es < '
Total Value(Line 3 plus Line 7) (6) N COU .24 .
Signature of Assessor Date Signed(date,month.t e`dr�V'-O',-„, J
I hereby certify the above is true,correct,and complete. /TOR
Venfying 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 S48.000
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 home
Signature of Auditor r Date Signed(month,day year
.
DISTRIBUTI Original-County Auditor.File-Stamped Copy-Taxpayer
v
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