Homestead_Bilderback (2) ri� ', CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'• ///' STANDARD/SUPPLEMENTAL DEDUCTION FORM
� State Form 5473(R19 1 1-23) HC10 MR .
•
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.
•� 1 CERTIFICATIONIF STATEMENT
3-
I(We) a(�(\C S r'h •t 1c`IL -V:ZIL lc, certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the f g descnbed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, —I....0-2L* (date of signature).I(We):
11;Km. ❑Am(are)buying under recorded contract.
❑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.
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
ty Townshi Taxing District(city,town township)
t�j tr1 f lar\CtS )
Parcel Number Legal Description Is the pro in question'
eat Property ❑Annually Assessed Mobile Hare(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.
.ti2 --t. 1' , ao 1 ^ 0°D.- 0-1 oo S
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Slate,County.and Township Is Claimant Vacatirngg a
Homestead?
'��'El Yes ,I�No /� 1
Signature of Claimant���'_""•� 1 k r
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street.city,slate,and ZIP code) Ad' ens of Vacated Homestead,if any(number and street.city,state,and lcode)-
1
03 r t r`ll�-t� _ �" l _" _, . IA-1Lt�r
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) F./LED
Total Land(line 1 plus lIne 2) (3)Residential Improvements or Dwelling (4)Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6) "UN 0 L+
Total Improvements(Line 4 through Line 6) (7) Q ��� bq
Total Value(Line 3 plus Line 7) (8) Ce$�`T{.4.... I^r
Signature of Assessor COON r • eeSig ed(date,month.year,,
I hereby certify the above is true,correct,and complete. V AUD/-.,'rG/
OR
ventying 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 848,000.
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 riot
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Sign lure of Auditor Date Signed(month,day,year)
cv,-,cLe_ Q 0 . ..k_'-.)(i_O-ILA:1-,,..4.)/ t_i2 -t_c2 -c9 •
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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