Homestead_Vinnedge a/ '�
��� YEAR CLAIM FOR HOMESTEAD PROPERTY TAX
��: STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1911-23) HC10 3
Prescribed by the Department of Local Gcvernment Finance ////
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.
CERTIFICATION STATEMENT
I(We) 1-.N C\C t5& I \t\n e 4 e_ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the folll w ng,tleeri c],teal propertt under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
t date application is signed l r y (date of signature) I(We)
Own El Am(are)buying under recorded contract
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
O 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 Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township ,Taxing District(city towntownship)
b\ Son C G( Y•09 i
Parcel)Number Legal Descnption Is the property in question
2 ll `P_3o p^ 1. - E Ret Property 0 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 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
Aounty,and Township // a / Is Claimant Vacatirn-g�a Homestead'
-1Gt��Y1 l/ J�//�� .0 ❑Yes LdNo i/H�r`�',/�;/Vf / /i Signatur of Claimant
I hereby certify the above statements life true,correct,and complete //' • �,
c--JJL't- �1 L G-.Itil�c-
Address of Contact(number and street.city.state and ZIP code) I Address of Vacated Homestead d any(number an trees.city.state and ZIP code)
7.
ASSESSOR USE ONLY ASSESSED VALUE I 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/ ILED
Manufactured Home Garage (5)Other Improvements (6) DEC 1 8 2023
Total Improvements(Line 4 through Line 6) (7) ,L I _+
Total Value(Line 3 plus Line 7) (8) `�•', .,,,- • &, J 1 41/�71app)
Signature of Assessor I Date Signed(date.month.year) 4,, �: �N A TtS g
I hereby certify the above is true,correct,and complete. I
Venlying 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-hall(1/2)of the assessed value of the mobile home or manufactured home
Signature of Auditor 64.7 Date Signed(month,d y.year)
DISTRIBUTION: Onginal-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2