Homestead_DeHut CLAIM FOR HOMESTEAD PROPERTY TAX
el�- YEAR
ell* ///' STANDARD I SUPPLEMENTAL DEDUCTION FORM 202
•y State Form 5473(R19/1-23) HC10
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 are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
(We) ? riary • certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dal is application is signed, (date of signature).I(We):
Own. ❑Am(are)buying under recorded contract.
❑ (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑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
C..)� PROPERTY DESCRIPTION
,/./ County � Township Taxing DDistrict(City,town,township)�0� O a9 •
Parcel Numb Legal Description the roperty in question:
Real Property ❑Arrrwalty Assessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun d that structure is used to produce income.describe the use and portion
Tof the property utilized to produce income.
2 - - 0 LI -- Dos OZ - O ? .
2._
� I � �
PROPERTY OWNED ELSEWHERE BY CLAIMANT
��\,/ State.County,and Township Is ail t Vacating a Homestead?
Xrrtorof
Yes ❑No
ClairstantI hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street city,state.and ZI de) Address of Vac H s ead,d ny(number and street.city.state,end ZIP code)
.4. J el ' 121: tArl'�lr�.S� N)In -'Y1-L SI ,f1L'
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE �
Land Not Exceeding One(1)Acre Immediately (1)
pigasaini
Surrounding Residential Improvement �
Other Land (2) Pit - 5J lv`.`',
Total Land(line 1 plus line 2) (3) CJ
um) .� r✓�
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/liczlir
/r/,4/ 4.1
�v
Manufactured Home Garage (6) ), (Th L \
Ci
Other ImprovementsCr
(6) �0?A �QJ (^
Total Improvements(Line 4 through Line 6) (7) G/es� T r
limmomiTotal Value(Line 3 plus Line 7) (8) ��♦,/�
Signature of Assessor qU0 h_ r .red(date,month.year) /
I hereby certify the above is true,correct,and complete. /�.O'paJ \ /
ZVerifying Action-Signature of Auditor R Date Signed(date,month,year)
O STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48,000. ' �^
1::
7\34's MEN:) Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ U
is not assessed as real property or to a manufactured home that is of assessed as real property may not \
exceed one-half(1/2)of the assessed value of the mobile -.T manufactured home. r-�
Signature of Audirn Date Signnon ,yea ^ r�-,11
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer (�/
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