Homestead_Jones \ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1:d STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R19/1-23) HC10
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) - at ' certify that I(we)occupied as my(our)principal place of
residence or am(are)buying t folri.eeal Ppp{Ry under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (date(date of signature).I(We):
ttQwn. ❑Am(are)buying under recorded contract.
❑Arn(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 temis 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
Cou(y Township Taxing Distri Ate,' .fM�wn,4hj/)
Parcel Viberr'J( � Legal Description Is theth property inin question:
Real Property ❑Annually 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.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stain r„riv and Township Is Claimant Vacating a Homestead?
❑Yes kNo
Signature o aimant
I hereby certify the above statements are true,correct,and complete. ��Q
Address of Contac umber and street,city,state,and ZIP .e) Cer Address of crated Homestead, any mbar an street, •city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential ImprovementsMoilor Dwelling (4) FILED
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) J U L 12 2024
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Dah.�ng ed(date,month,yyar)
I hereby certify the above is true,correct,and complete. /rY(]K_-c,14it_G_C/ C4// df//1l'/
Verifying Action-Signature of Auditor DaPACAtIcacygli4470Y AUDITOR
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 properly or to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assess of tt mobile home or manufactured home.
Signet e I_itoi / /1' /f��/ ��rklitief/ Dateign/(month da r)�14
I�///�/� ✓�
l/J 02.�' oc
116
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpay {`
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