Homestead_Heofling a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r�i ' STANDARD!SUPPLEMENTAL DEDUCTION FORM
r. 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) 1V' lI k�\ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the 11914 v rg„[i it r'.e�r�e�Operty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
tot. pplication is signed, Il ((�J !\ VVV��� (date of signature).I(We):
wn. ❑•m(are)buying under recorded contract.
A 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 terms cif 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 r
! Townshi Taxing District city,town,towns '.-
02-1
Parcel Number Legal Description �.V./ Is the property estion:
7.1.0'1 7'I I*I CO-OO$+14Q•Az, m Real Property ❑Annually Assessed Mobile Home(IC f 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.
JU
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead? 0..0MO
Yes ❑No t
Signatur fCiaimant ( _�
I hereby certify the above statements are true,correct,and complete. /X� t/V
. Address of Contact(number and street,city, te,and ZIP code) Address of Vacated Homestead,if any(number a street.city,,and ZIP cod
t5 7ic>z w5 �' ow,, La. 02,6' w N.... 6,8 c is,Qdt V 47639
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE 4
Land Not Exceeding One(1)Acre Immediately (1)
r4
Surrounding Residential Improvement
1 CO
Other Land (2) �- ,
Total Land(line 1 plus line 2) (3) l Oc-i 8 ,
113
Residential Improvements or Dwelling (4) e=
Annually Assessed Mobile I im3) ' h
Manufactured Home Garage (5) ..{ V D
1— 0
Other Improvements (6) O U
Z
Total Improvements(Line 4 through Line 6) (7) d O
CO
Total Value(Line 3 plus Line 7) (8) ry� (a
Signature of Assessor Date Signed(date,month.year) 1.Cri'
I hereby certify the above is true,correct,and complete,
Verifying/Action—Signature of Audit r /, ,'^ Date Signed(date,month,year)
Ali
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(112)of the assessed value of the mobile home or manufactured home.
Rim.
SigtuA ^ ,/I1 T Date Signed(month,d y,year)
/jjj(y( iiii j'L/-C't 1/O/// ��0 a� tX
DISTRlBtfTION:Origmai—County Auditor.File-Stamped Copy—Taxpayea_lll!!llll!!! Page 1 of 2