Homestead_Brakmeier ei A:,
CLAIM FOR HOMESTEAD PROPERTY TAX
'� STANDARD I SUPPLEMENTAL DEDUCTION FORM
i• State Form 5473(R19 11.23) HC10 d��/Il 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
+
I(We) •r�/ a nnta PA. certify that I(we)occupied as my(our)principal place of
residenc-or:m(a e)•uying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date! 's •?icatio - signed, (date of signature).I(We):
Own. ❑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 light 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.
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County ^ Township Taxing ct •we tt'o�wnship)
S�1 \ 02� '
Parcel Numb$ Legal Description t property in question
ear Property 0 Annually Accr coed Motile Home(IC 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately su unds hat structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2 — 17. --0 s---- 4:0 0 00 0 - 7 k-0 .. - •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati g a omestead?
❑Yes No
vSi•n.ure of Claimant
I hereby certify the above statements are true,correct,and complete. f(
Address of Contact(n er and beet,city,state,and ZIP d i •d ess of a dated Homestead,if any(nu er'd street,city,state,and IP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land NotExceeding One(1)Acre Immediately (1) Pit
SurroundingResidential Improvement
Other Land (2)
Total Land(fine 1 plus line 2) (3) ki.,
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I S
Manufactured Home Garage (5) �
Other Improvements (6) O %024 Total Improvements(Line 4 through Line 6) (7) 043, C-X.,Total Value(Line 3 plus Line 7) (8) O C'N•
Signature of Assessor OV'V�^� Date Signed(date,moth,year)
I hereby certify the above is true,correct,and complete. Al 0
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Verifying Action—Signature of Auditor O+7 Date Signed(date,moth,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 manufactured home.
Signature of Auditorpcwo\ D gn d(mon day,year
DISTRIBUTION:Original—County Auditor,File-Stamped Copy—Taxpayer
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