Homestead_Sullivan (10) C4, CLAIM FOR HOMESTEAD PROPERTY TAX
ii.• _. ;;! STANDARD/SUPPLEMENTAL DEDUCTION FORM
mw....1, State Form 5473(R19 t 1-23) r'2+0 2-t-I HC10
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Prescribed by the Department of Local Govemment Finance YEAR
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) Fit a vs; T 0
certify that I(we)occupied as my(our)principal place of
residence or am(are)buying thtto 194s. iNal property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, J, (date of signature).I(We):
Own. DA (are)buying under recorded contract.
i'IJm(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
D Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 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 District(city o
\O'le-\ 0 24'- ‘ •
Parcel Number J
Legal Description I Real Property
in question:
DAnnuatty 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 surr nd that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
-7-02_.- 001-) • Efl
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is Claimant Vacati g a omestead?
0 Yes No
Signet re laimant
I hereby certify the above statements are true,r and complete.
Address of6ontacInbetain6Sikrel_city,state,an ZfP code) , Address o a ted Homestead,if any(number and street,city,state,and ZIP code)
0 '*-- - VII'', % e— t• .
ASSESSOR USE 0141A I ASSESSED VALUE I 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) .
' r
f I
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) SE?. 7 1°2'4.
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) a ihaA6-014)
th,,,A, wr, worToR
Total Value(Line 3 plus Line 7) (5) GIBSC1C°U
Signature of Assessor Date Signed(date,month year)
I hereby certify the above is true,correct,and complete.
Verifying 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$48,060.
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 toe manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor ii.,\‘..0 otlid‘,) ....Th, Date Sil( o2.7a i(„2.erici
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpa i .1
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