Homestead_Smith (52) s` CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION FORM YE�7AR
•,, State Form 5473(R19/1-23) HC10 (i1
Prescribed by the Department of Local Government Finance
e40INSTRUCTIONS: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) 1 1�/ 1 Q r^ certify that I(we)occupied as my(our)principal place of
reside :or am(a„F,`G!(,,uying#he folk* g e n'be�lit la property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
a is application is signed. 5 I 1-7", , (date of signature).I(We):
Own. l' ❑ m(are)buying under recorded contract.
❑ (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑Have a beneficial interest in the bust or the right to occupy the property under the leans 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
PROPERTY DESCRIPTION
County Township .g District)cdy,town,townshni v-- ,
�� _ 2� vDS f l
Parcel Number Legal Description I theproperty in question
Real Property ❑Arnualy Assessed Mobile Home pc 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun rid that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2 6 --i 2 - 0 - t O r-- Ov01 S-2�- -- 02 N
PROPERTY OWNED ELSEWHERE BY CLAIMANT 1
State,County.and Township � r An.0/� rP /:Is Cl i and Vacating a Homestead? N
/ , es ❑No
tut
I hereby certify the above statements are true,correct,and complete. Q
Agdrgs.f onlact(number a reef,c ty state.and ZIP code) Address of Vacated Homest..d,if any(number and street.city,state,and ZIP code) L./1142( � 1• , •can IliD,1 -Jn- `4-61-D IL-1e'1 - €1 • , IZA P` -fin --0-60<
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement 0
Other Land (2) 0
Total Land(Ilne 1 plus Ilne 2) (3)Residential Improvements or Dwelling (4) OAnnually Assessed Mobile/ ��� ,4
C-)-- )
O)Manufactured Home Garage (5)
Other Improvements (6) � ''� (�
Total Improvements(Line 4 through Line 6) (7) , A� ��(��••////
{ 4—
Total Value(Line 3 plus Line 7) (6) ��von-4 �Zo G
Signature of Assessor N � IAte Signed(date,month.year) 1
C
I hereby certify the above is true,correct,and complete. O C.
CO/
. G
Verifying Action-Signature of Auditor yq Date Signed(date,month,year) l
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 mobil: anufactured home.
Signatu l uditor `I Date Signed/NI, r2 D. t,
1 N ,
DISTRIBUTION: Original-County Auditor,File-Stamped Co. yer6
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