Homestead_Love ,s CLAIM FOR HOMESTEAD PROPERTY TAX '�r;� A.
STANDARD/SUPPLEMENTAL DEDUCTION FORM
'� State Farm 5473(R19 11.23) HC10
' Prescribed by the Department of Local Government Finance v
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under/C 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) ' eSkt. - certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the fielb�tg dts 6ltd al.groperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application is signed, LJ (� 1'<J L—1(ate of signature).I(We):
wn. ❑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 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 Township Taxing District(city,town,township)
Parcel Number Legal Description Is the property in question:
0 Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7)
If any portion at 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.
<"),,,_C .--- 1 2,"-' 13 4100 —floc . 58 2_-05
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacatin a mestead?
0 Yes
Signatur/
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,city,state,and ZIP code) Address of Vacated Homestead,if any(numbe and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE 1 HOMESTEAD VALUE I 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 Improvements or Dwelling (4) pi-L
Annually Assessed Mobile/ f '�
Manufactured Home Garage (5)
Other Improvements (6) (//t
Total Improvements(Line 4 through Line 6) (7) -c7-2^� i 1 2024
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor 3/8s,7 Date Si ned(date,month.year)
I hereby certify the above is true,correct,and complete. ON CO,;—`-;
�fA e� J
Verifying Action-Signature of Auditor MTIda"�15'Z d,lAOdivginonth,year)
jf p
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 property may not
exceed one-half(1/2)of the assessed value of the mobile h ufactured home.
Signature of Auditor
Da} 8 ad(Gh,gay,year)
' I Ue O r c.?„
DISTRIBUTION: Original-CountyAuditor,File-Stamped Copy- r `\\
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