Homestead_Schmitt (11) ¢' CLAIM FOR HOMESTEAD PROPERTY TAX
' STANDARD I SUPPLEMENTAL DEDUCTION FORM YEAR
y State Form 5473(R19/1-23)0HC10 l�. .
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
I(We) ''Of'• ia� Q• �e ,5 ,c`M•t certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real p erty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
daterrr his application is signed, (date of signature).I(We):
IJCvwn. ❑Am(are)buying under recorded contract.
0 Am(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
PROPERTY DESCRIPTION
Counin Township Taxing District(city,town,township) /�
, b unt,sLic-- o2s
Parcel Number Legal Description Is the property in question:
eat Property ❑Arcaaly 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
QLo~ \cl- Dq -\-1 OO - op . 2"• oil- C .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township
Is Claimant V eating a Homestead
es ❑No b`'
1Signatu f Claim t _ ���I, OC A U ,]r 1.+n
I hereby certify the above statements are true,correct,and complete. ; )/_Pl//e fry s_(JA Jam/-^�',',Ti[_ e� cf
Address of Contact(number and street,city,state,a •ZIP code) Add of Vacated Home lead,it any(number and street,city,st te,and ZIP rod) �1•' '
1 D C. . •at 'r . iI di I g 4 £ 9 " . 1 4 _ ��r_� ..1t) • ^N
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE -NON-RESIDENTIAL VALUE t 0...'
Surrroundinnd Not g Residentine tial Improvement( AImmediately (1) (1�1 ,
Other Land (2) `^� lSv / n
1
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ S
Manufactured Home Garage (5)
1
Other Improvements (6) Pit
4-71)
C
Total Improvements(Line 4 through Line 6) (7) 4 y 2 ^)
Total Value(Line 3 plus Line 7) (8) 24,24 0
Signature of Assessor Datti941_q{ a th.yajr) D G
I hereby certify the above is true,correct,and complete. v `, • .
Venfying Action-Signature of Auditor Date Signed(data,oo�4114
q UO�T�
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48,000. "-0
1
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ 0
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.SI ,
\P(..\/.. .re of Auditor a ` v_ �` . J�.f,?,..3Date Signed(month,day,year) y 1
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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