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. • 4.,- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
($ STANDARD / SUPPLEMENTAL DEDUCTION FORM
`:•: . State Form 5473(R20/12-24) HC10 O
Prescnbed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone Social Secunty drivers license. state identification and federal identification numbers are confidential under 1C 6-1 1-12-37
^- CERTIFICATION STATEMENT
I (Wel k 0�S i ma ► • t CLL. . ' kA..T%fS . -_ certify that I (we)occupied as my (our) principal place of
residence or am(are) buying the following.desci property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed 1 _ (dale of signature) I (We)
3.4 I] Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the nght to occupy the property under the terms of a qualified personal residence trust
0 Am(are)the shareholder partner or member of the entity that owns the property
If Buying on Contract Fee Simple Owners Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County T wnshi Taxing Distnct ic:ty.town.toi,,'ship)
C.... .L� V -• OIL 311)%44"4:4-.0 ,
Parcel Number Legal Description Is the property in question
real Property ❑ Annually Assessed Mobile Home(IC B.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
ki k _ k .D04, .. OOP . ..7-- C. .-1 .
c=,: (....0 .....
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township Is Claimant Vacating a Homestead, (((`���►�`1��ll\1\
%---- - �_ - es ❑ No Y
Sgna of Claimant
I hereby certify the above statements are true, correct, and complete m i n
Address of Co tactt(number arid street. city, state, and code)V A dress of Vacated
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) l
Total Land (tine 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l
Manufactured Home Garage (5)
F:12LEIM
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7) OEC O '
10?5
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed (date. month.year)
I hereby certify the above is true, correct, and complete. GI
Verifying Action-Signature of Auditor
SSnN 0tity&K th 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 Date Signed(month. day. year)
a ,363- \-- - I-a= .
DISTRIBUTI N: Original-County Auditor File-Stamped Copy -Taxpayer
Page 1 of 3
H. PREPARER10 I
Preparer of the Sales iscl sur Fie n 'leeiLd0
�,/
Payge Marx Es row Officer
Company
Address(nu ber and street,city,s , untry,and ZIP Code)
7412 Eagl- Crest Blvd Evansville, IN 477
Last 5 of SSN: - L -33 l Last 5 of SSN: g• Z%Q8'
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