Homestead_Grey e, a, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,�; •' STANDARD I SUPPLEMENTAL DEDUCTION H RM 10 �.L`
;' State Form 5473(R19 I 1-23) `�
Prescribed by the Department of Local 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) 0 1. ()n) Q/\ \ • certify that I(we)occupied as my(our)principal place of
residence or am(are)buyi •the of. ing descn.:.real p•.erty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
ate is application is signed. (date of signature).I(We):
n. ❑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.
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township(
Taxing Distnct(city.town,to ip)-7N
Parcel Number Legal DesptiDescriptiontion s t eR property in question
��VJJJJ I Real Property ❑A Assessed Motile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surro ds t structure is used to produce income.describe the use and portion
of the property utilized to produce income.
Z. 64 .-- 11 .-. 1 n — '3°0 0 ---JD 0 Ot 3 '0 2-
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is C im Vacating a Homesl3 d�
es ❑No /
Sign re of lament
I hereby certify the above statements are true,correct,and complete. / QC�'/(/
Addr s of Contact(number and street city s d ZIP code) A ress of Vacated Homestead.f any(numb d str-et city.fate,and ZIP code)
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L v kV) - — , --°V11
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NUN-RESIDENTIAL VALUE
Land Not Exceeding One Acre Immediately (1)
SurrouundingingResidential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I k
Manufactured Home Garage (5)
-4?)
Other Improvements (6) C/e6'0 D�jO�A
Total Improvements(Line 4 through Line 6) (7) C.0 C ? x
'll
Total Value(Line 3 plus Line 7) (8) f'
Signature of Assessor Date Signed e year)
I hereby certify the above is true,correct,and complete. /r.
Venfying 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$48.000.
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 ' home or manufactured home.
Signature of Au /\�' t S Date Si s q/f(h. y 21-i '
DISTRIBUTION: Onginal-County Auditor,File-Stamped axpayer
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