Homestead_Burrell (2) e 'p CLAIM FOR HOMESTEAD PROPERTY TAX
' STANDARD/SUPPLEMENTAL DEDUCTION FORM YEARr
,, State Form 5473(R1911-23) HC10 7/(Th tit .
Prescribed by the Department of Local Government Finance !► _1
NOTE:INSTRUCTIONS:, o reverse side for filng instrulicense,
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NOTE:Telephone,Social Security,driver's license, -at: de / fin and f rt(i numbers are confidential under IC 61.1-12-37.
CERTIFICATION STATEMENT
f,- 0 V 2AF certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following descri Vial al property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
d t is application is signed. (date of signature).I(We):
4Own. ❑Am(are)buying under recorded contract.
/ m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
ave 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 /Jki\ Township O . Taxing District(city,town,to • p)
, rYNn
Parcel Number Legal Description 1 th roperty in question:
Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately su ound that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
26, ) 2 - 1 $ loci _ odt . z) 6 -o7s •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township
Is Claimant Vacatin a omestead.
❑Yes No
Signature of Claimant ` ,c��I I hereby certify the above statements are true,correct,and complete. CCWI'Vce .V
Address of Contact(number and sire',oily state.and ZIP code) Address of Vacated Homestead.if any(number and street,city,slate,and ZIP code)
{� _ Q ) I „n -- h n 1, 1
ASSESSOF.USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) lI111E11I '
T Total Land(Ilne 1 plus Ilne T) (3)
Residential
ually ob or Dwelling (4)
Annually Assessed Mobile/ 1'
Manufactured Home Garage (5) UL 15 ZU24 (--"
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) �_ __/ a4//f0/
Total Value(Line 3 plus Line 7) (8) GI/B OI�LuC�(OUNTY AUDITOR
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete.
Venfying 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$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 th assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile ho e o ma lured home.
Signature of Aud or kj \ Date Sign �ontr,�yaar) �' -
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DISTRIBUTION: Original County Auditor,File-Stamped Copy-Taxpayer
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