Homestead_Creamer (2) 111
CLAIM FOR HOMESTEAD PROPERTY TAX
.7L ' STANDARD/SUPPLEMENTAL.DEDUCTION FORM �t YEAR r
F State Form 5473(R19/1-23) HC10 1740A t
},'•. 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.
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CERTIFICATION STATEMENT
I(We). "�Jj t 01 0, certify that I(we)occupied as my(our)principal place of
residence or am Care)buying the foilP/4 ttc' r.a property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, I!t(L(l�4.11 ' Gf'+ (date of signature).I(We):
X Own, ❑Am(are)buying under recorded contract.
❑Am(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 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 Owners Name
Recorders Office Where Contract is Recorded / Record Number Page
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PROPERTY DESCRIPTION
Coun Township7 Faxing District 'ty fo n, w hi)
Parcel Number - Legal Description '"
VfReal Property ❑Annually Assessed Mobile Home(IC6.1,14)
11 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.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,Count/and Township
Is Claimant Vacating a'Homestead?
❑Yes )�`` l(.
No /���
Signature of Claimant elf,'
'.a hereby certify the above statements are true,correct,and complete. /' r : [�t�2lrn++
A re s of Contact(nu b rand street,city state,and ZIP code) Address of Vacated Homestead,if any(number and street,city,stated ZIP code)
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE .
Land Not Exceeding Ono(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3) PI
Residential Improvements or Dwelling (4) -
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Annually Assessed Mobile/ -�
Manufactured Home Garage (5)
Other Improvements (6) NOV 01 ao24
Total Improvements(Line 4 through Line 6) (7) Qs tali »
(7?
Total Value(Line 3 plus Line 7) (8) ONco/Jt� 4
Signature of Assessor. Date Signed(date, rearl
I hereby certify the above is true,correct,and complete. ' (10jrO
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 648,000.
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 asses d value of e
mobile
�home
/or manufactured home. ///
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DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpay
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