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Homestead_Shuttle (2) e CLAIM FOR HOMESTEAD PROPERTY TAX l YEAR ) �i ;; STANDARD/SUPPLEMENTAL DEDUCTION FORM I State Form 5473(R19/1-23) 2.3 Hnu) . Prescnbed by the Department of Loca,Government F.nance 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 /x C- _. certify tnat I(we)occupied as my;our)principal place of reside'IPdam(are)r yin the fol owing described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is -•- (date of signature) I(Wel ❑Own ❑Am(are j buying under recorded contract 0 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 entty that owns the property If Buying on Contract.Fee Simple Owners Name I Recorder's Office Where Contract is Recorded I Record Number I Page i PROPERTY DESCRIPTION County C ^ Township ©� Taxing Distnct(city town.township) fJ0 • Parcel Number Legal Description ' the operty in question eat 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 immedately surro s t t structure is used to produce income describe the use and portion of the property utilized to produce income bk -2-tA-- 3-07 - 000 . \\6‘- 0 1 '5? . PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County,and Township • s Cta nt Vacating Homestead/ - -- es No Si afore of COrnant YYY����11 I hereby certify the above statements are true correct.and complete Address of Contact inumber and street city state an P co e) Ad ress of Vac stead.if any(number and street city.state and ZIP code) I No - O Id ° a �3n - ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTI',_VA,UE Land Not Exceeding One(1)Acre Immediately (1) Surrounding Residential Improvement Other Land (2) plus Land(line 1 line 2) (3) e • .',11 %):6 Residential Irriprovemen or Dwelling (4) .ts• _ & Annually Assessed Mobile I Manufactured Home I Garage (5) Q• T T .'V.. 4J' . Other Improvements (6) r Total Improvements(Line 4 through Line 6) (7) iiO''C- I Total Value(Line 3 plus Line 7) (g) I OR Signature of Assessor i Date Signed(date month.year) I hereby certify the above is true,correct,and complete. Verifying 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 Noty rthstandmg 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•• - sensed as real property may not exceed one-half(1/2)of the assessed value of the mobile home• - lured home Signature of Auditor - Dr^ ` ---- -- Date Signeg rnont y r --- ,Th n itzi L _ 1111(\ 'IlCIAIn DISTRIBUTION: Original-County Auditor File-Stamped Copy-Taxp--- Page 1 of 2 t