Homestead_Ayers "\ CLAIM FOR HOMESTEAD PROPERTY TAX f YEAR -
; • t' STANDARD/SUPPLEMENTAL DEDUCTION FORM ^/�
11111.0p 'i State Form 5473 iR1g i 1-23'l - T, _ HC10 j l�Z_, ,
• - p es✓_ed or brie Ce,a:me-t of LOSS :_.e-.T_ 5-ce
/NSTRUCTIONS 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;wed, ;blInc 7 OrS, __cert;toe.I lAe,i occur ed as my'our prIncipa'place of
res'dence or am(are;buying the tot . 7 desor red rea.property,rder zo:Vact•for.v'-sr a'ion es:ea3 Property Tax S:andaro Ded.,nt cr•.s fe'eo a^red oar-t`e
date -S appiicadcr,s sgned (date of signature) I
❑A. a-e c..,_ -d,rec0-oeo ocrt•act
! ❑A. (are,enbtied to occupy as a tenant-stos,mo ce-e'a__coe'atie hoes rg corccra:o-
❑Ha.e a oerettca.nterest m the trust or tie-._ -.ccery under try:e--s:f a q.a s,na'-es deuce:^_st
❑Am;are,the shareholder,partner or member o`t-e ent t,.,_ _• e_
4 Buying on Contract Fee Simple Owners Name
Re_c'ler s Office Ariere Correct s Recorded w Reco•o tiuTher I Dade
PROPERTY DESCRIPTION
Court'? C T e.-. ,
a .cmcer V •
1 O - - s t". -o Ferty r 7..es!oro , —�
:' �'.: •
-ea.P'ope^y ❑Ar.r,uaiy Assessed t/otvie f-om.e CC,'1.'.
___ a s _, _ : :' -cite'1 a❑re that mmned,ate y svr cods at st-ucir re s ased to orcduce income describe the use arid porter
Zg- 11--\ - 1g - \OL\ - 00/0 .32 3-- - 0
C9
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Is Claimant Vac-.r-Lorrestead'i
❑res
I hereby certify the above statements are true correct and complete -
Add-ess:Cc^tact•r;.mbe'and stree' arty state 353 ddress of.eca'ed r'cr-es'aai t ant i•,.moer and street ,:y state ar-d Z.°_,1:e
ill) W Col 1 * t. Si' 01 c\ .
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately
Surrounding Residential Improvement I CO
' Other Land ;2'
Total Land(line 1 plus line 2) (3) I
Residential Improvements or Dwelling i 14,it' E:=E1:11)
Annually Assessed Mobile 1 —
Manufactured Home I Garage ';5;
Other Improvements I(6: , MAY 03 2024 '
Total Improvements(Line 4 through Line 6) '7'
Total Value(Line 3 plus Line 7) I(8)
_ CiesaNl'� :,�_
S.gratJ•e o'Assess,
1 I hereby certify the above is true,correct,and complete. AUDITOR
Verfyrg Action-S g-ature of Aco to- ---. Cate Sigred date mortr yea„
STANDARD DEDUCTION ALLOWANCE
26__Pay 20 Lesser of SC",of the assesses.i -_ _ .._ ... _ -
Notalnstanding any Olsen er7i6icn 'he 5..T _..^0LOhOr5 prli'dec r i1:.5-1 1-'2 to,a-rOt e _r'',..'
is not assessed as real proper/Or tc 3 i -ore'hat s not assessed as-ea-grocery-py cot
erceed one-bait-h'2,)of the assessed..-_. _ - manufactured-cone
it Signature cf Audi i Date Si ed! rtn y„rtt. LA
1")
DISTRIBUTION' Dr,cal-:ourty a_ded. =de.Stamced-op - v
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