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Homestead_Palermo CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD I SUPPLEMENTAL DEDUCTION FORM •y M) State Form 5473(R19/1-23) HC10 `_i.i 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 r I(We) O certify that I(we)occupied as my(our)principal place of resident=•ram(are yang the following descnbed•real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the to th application fined. (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. If Buying on Contract,Fee Simple Owner's Name Recorder's Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County - on Township Taxing District(city,town,I. hip ^ 1 Parcel Number Legal Description V • Y Is th roperty in•uestiom Real Property ❑Arrxlalty 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 ou s that structure is used to produce income,describe the use and portion of the property utilized to produce income. 26 , 6 L -z� ^ 104 ^ .0 W . Li 6S -O2o 1 PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County.and Township Is i Vacating a Homestead? es ❑No �� ` / Si t laimant a / J I hereby certify the above statements are true,correct,and complete. �/n K T IG Address of Contact(number and street,city,state,.rid ZIP code) A s of t estea d my um rand .et,city,state,and ZIP code) ASSESSOR U,E ONLY I ASSESSED VALUE I HOMESTEAD VALUE NCN-RESIDENTIAL VALUE • Land Not Exceeding One(1)Acre Immediately (1) Surrounding Residential Improvement Other Land (2) Total Land(line 1 plus line 2) (3) FILED Residential Improvements or Dwelling (4) Annually Assessed Mobile/ Manufactured Home Garage (5) 11 Other Improvements (6) JUN 2 8 2024 Total Improvements(Line 4 through Line 6) (7) Total Value(Line 3 plus Line 7) (8) -424 / fA/' L BB44 Signature of Assessor GIt3SUN COUNTY yA-m1 f p(date,month.year) I hereby certify the above is true,correct,and complete. VV FFCC Venfying Action-Signature of Auditor Dale 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 properly may not exceed one-half(1/2)of the assessed value of the mobile home or manufactu Signature of Auc�ify. Date Sign (mom , y, ear & /211. DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer • Page 1 of 2