Homestead_Simmons e`���'� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
"'lit\ STANDARD/SUPPLEMENTAL DEDUCTION FORM )-
'/ State Form 5473(R191 1-23) HC10 —2—(0L
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'�i- Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE.Telephone,Social Security,driver's license.state identification and federal identification numbers ate confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) MET ' cert,fy Mat I(we)occupied as my(our)principal place of
reside or am(are)buying the follot n delcn prgtyert�un r Corr ct for which a Homestead Property Tax Standard Deduction is hereby claimed on the
ate is application is signed, (are) /�\.,r slgnaturel I(We)
Own Eltare) uyirg under recorded contract
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 H 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
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
C�tunty � Township Ta//x'in��g District(city.town,township)
"iNati
Parcel Number Legal Description ``� Is the property in question �•
al Property ❑Annually Assessed Mobile Horne(IC 61 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
•
Or
PROPERTY OWNED ELSEWHERE BY CLAIMANT l
State.County.and Township Is Claimant acating a Homestead'
pwc"; ❑No
Signature la, art/4t l
I hereby certify the above statements are true,correct.and complete iX G
Address of Contact(number and street.city state and ZIP code) t Address of'placated mes=.d i any(number and street city state and ZIP coder —
\ ^ r c
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE f�
I
Land ExceedingNot One(1)Acre Immediately 1 O Q
Surrounding
Residential Improvement
Other Land (2) I
Total Land(line 1 plus line 2) (3) 14,e O
Residential Im rovements or Dwelling (4) 1 `�
Annually Assessed Mobile l -_-- D`(. CD
Manufactured Home Garage (5) 90� .�
Other Improvements (6) t; `
Total Improvements(Line 4 through Line 6) (7) /86O^/0 \
Total Value(Line 3 plus Line 7) (8) Lirst.N ,C'�
I.e t
Signature of Assessor •�Q/7•0q l�/I Date Si d(date.month pearl /1\
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor Date Signed(date month,year) N
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 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
Dare 4,,,,,.. r th.d v"irr)�2/1 Signattor /`� _ (1 1 I . ,v, f�l/7 _1 2 / !� J_---�—_
DISTRIBUTION: Original-County Auditor.Fite a.r c.2v :_..- V
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