Homestead_Stocker ', CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' STANDARD I SUPPLEMENTAL DEDUCTION FORM - �f�
\,. N State Form 5473(R19/1-23) HC10 � C.
•
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
',rt I(We) �t .- C •cv c- 1 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (date of signature).I(we):
❑Own. ❑Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the tight to occupy the property under the terms of a qualified personal residence trust.
❑Arn(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 3� \ Township Taxing Distric city township)
Parcel Number Legal Description I the perry in questi •
eat Property 0 Annually Assessed Mobile Horne(IC 6-1.i-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surro ds t at structure is used to produce income.describe the use and portion
of the property utilized to produce income.
Z6- 0 S------Li o — l CA
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale,County,and Township Is Claimant Vacating a •mestead?
❑yes IA No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and ef,city,state.and ZIP code Address o1 Vacated Homestead,if any(number and st==t,city.state,and ZIP code)
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) FILE
Total Land(line 1 plus line 2) (3)Residential Improvements or Dwelling (4)Annually Assessed Mobile I
Manufactured Home Garage (5)
C.� ✓UNici---'14 r �
Other Improvements (6) 2024
Total Improvements(Line 4 through Line 6) (7) /� \
Total Value(Line 3 plus Line 7) (8) G> A
Signature of Assessor Q�Y�CQ/, Si ned(date,month.year)
I hereby certify the above is true,correct,and complete. �q /T
Verifying Action-Signature of Auditor °aid SON(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 povision,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: • - manufactured home.
Signature of editor ,-� c� 6 Date Slgs ( th, yer d , ^
r)_
DISTRIBUTION: Original-\)County Auditor,File-Stamped Cop• . sayer •C//, .
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