Homestead_Hope (4) ''"'n ''\x CLAIM FOR HOMESTEAD PROPERTY TAX I _ 1
(ill. i' STANDARD/SUPPLEMENTAL DEDUCTION i FORM YEAR
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/ State Form 5473(R19/1-23) HC1t! 90�^-+ 1\_r•/ Prescribed by the Department of Local Government Finance AckI0INSTRUCTIONS: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 /wt� ,
I(We) tM,n[• •
/ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying th II w�- n edtreel�roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the (� C
d to is application is signed, • (J . (date of signature) I(Wej
n Am iarei buying under recorded contract
❑ (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
je)210 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 I°age
PROPERTY DESCRIPTION
County i_- 3^ Township ^ \.,.... "axing District(ci to township)
Parcel Nu be Legal Description h p•.erty in question
•
�I-eal Property ❑rally Assessed Mobile Horne(IC 6-11-7)
If any porton of the res'dential structure or the land not exceeding one(1)acre that.rain od,a:e''y sort!, ds at structure is used to produce income.describe the use and portion
of the property utilized to produce income
2..._.0 eg— \1.—20 0 — (.4— Q)>-2_--kp 1+—
,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vaca g Homesteads
--- I ❑Yes B.No
S era r_o!�y�, � ...000111
I hereby certify the above statements are true.correct,and complete `
Address of Contact(number and tr et. state and 2iP code) _.dress of cheated Homestead d any(number and street city.state and ZIP code)
24g E-SY�cI okc - —MI6
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) •
Surrounding Residential Improvement __ ____ _ __
r _. --
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) �',,,
Annually Assessed Mobile I I
40,00
Manufactured Home Garage (5) _ Fj�1
Other Improvements (6) (C V '
pz
Total Improvements(Line 4 through Line 6) (7) C/e 0 q
Total Value(Line 3 plus Line 7) (8) 1 ukT}��,
Signature of Assessor Date Signed(date rrlq
V
I hereby certify the above Is true,correct,and complete. /7. n l
Verifying Acton-Signature of Auditor '.Date Signed(date month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed,_: , .;:.id or S48 CCC
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-t2 to a mobile home that $
is not assessed as real property or to a manufactured home tha ses ed as real property may not
exceed one-half(1/2)of the assessed value of the mobile ho or nu to d home
Signature of Auditor pr)1 ^ .. _ — Date S,sed iTn th, a yearlW L� " "�2J/
DISTRIBUTION, Original-County Auditor File-Stamped Copy-Ta er
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